(J? The Elements of Medical Eminence. INTRODUCTORY ADDRESS, DELIVERED BEFORE THE MEDICAL CLASS OF THE MEDICAL SCHOOL OF MAINE MARCH 13, 1848, >! EDMUND R. PEASLEE, A. M., M. D., PROFESSOR OF ANATOMV AND SURGERY. ^ublistjeU bfi tjje (Klass. zoiff PRESS OF J. SR1FFIN,.....BRUNSWICK. 1S4S. Brunswick, March 13th, 1848. Prof. PEASLEE, Dear Sir,—The general satisfaction given the Medical Class by the delivery of your excellent Address, has induced a universal desire among its members that it may be possessed by each of them in an enduring form; and at a meeting of all the Class, we were appointed a Committee, in furtherance of this desire. We now have the honor to make known their wishes; and most respectfully ask of you, at 3rour convenience, a copy of your eloquent Address for publication. Very truly, your ob't servants, GEO. B. UPHAM, j J. W. MURRAY, > COM. D. C. MOORHEAD, ) March 14th, 1848. Gentlemen,— I have the honor to acknowledge the expressions re- specting my Introductory Address, contained in your communication of yesterday, and your request for a copy of it for publication. It was very hastily prepared, and merely with the hope of calling the attention of the class more especially to the moral elements of pro- fessional eminence. On account of the importance of its subject, therefore, though with a full sense of its numerous defects, I have de- cided to comply with your request. With sentiments of high esteem for the individual members of the Class, I am Very faithfully yours, messrs. geo. b. upham, ) EDMUND R. PEASLEE. J. W. MURRAY, > COM. D. C MOORHEAD, ) ADDRESS. Gentlemen— To all who aspire, as I trust is the case with yourselves, to the highest rank in the profession you have chosen, a ques- tion of the highest importance now at the commencement of your course of study, is—" What are the elements of true emi- nence in the medical profession ?" To furnish a reply to this inquiry, as satisfactory as my allotted time will allow, and thus to guard you against certain erroneous but far too common notions on this topic, is my present object. Genuine eminence is a result, which its appropriate caus- es alone can produce; and no anticipations of its future at- tainment are to be realized, except by those in whom those causes act. It is not the result of accident, nor of calculation, as many would fain believe; but is the natural product of ac- knowledged excellence. It is a structure reared by no adventi- tious process; and genuine merit is its sole foundation. Eminence is too often confounded with mere popular- ity. Both imply a reputation, indeed. But one may be popu- lar without true merit; eminent he cannot be. Mere tact may secure popularity, even in the absence of all excellence; exter- nal circumstances alone may bring it; but the elements of your future eminence are internal—they exist within yourselves. Popularity is necessarily of merely local extent, and transient in its duration; eminence finally becomes world-wide in its expan- sion, and is in its very nature imperishable. The former is worthy to be coveted by only the smallest minds; while true eminence is worthy the aspirations of the noblest human intel- lect, and would not tarnish the glory even of angelic powers. 6 Nor must eminence be confounded with mere distinction. Wealth, family connexions, or influential friends, may confer the latter for a time. A single fortunate act may give one notoriety; so may a disgraceful one, or a crime even. Emi- nence implies distinction; but not such as depends on the inter- ested opinions of a few, or is based on a single achievement. It is acquired by a continued course of meritorious actions, and is implicitly yielded as a just claim by all. To say a physician is distinguished, is often a very equivocal compliment; to say he is eminent, is never so. Therefore we must distinguish the desire to attain to emi- nence, which has been commended, from a desire to secure reputation merely. The object of the former is a deserved rep- utation, and is consistent with—perhaps I might also say neces- sitates—the purest motives; the latter merely seeks the gratifi- cation of our own self-love. He who is influenced by the for- mer, would make a fair purchase; who succeeds in the latter way, commits a theft. To desire to secure the esteem of our fellow men, is most laudable; the mere love of praise is an im- pulse that can never be safely trusted, and never leads to emi- nence. Still the latter is a motive common, in some degree, to all; while the former actuates but comparatively few. " The love of praise, howe'er concealed by art, Reigns more or less and glows in every heart; The proud, to gain it, toils on toils endure, The modest shun it but to make it sure. "* But to seek applause for itself alone, will render you selfish and unscrupulous; and finally preclude all true eminence. First strive to deserve commendation ; and this being accomplished, it will infallibly be awarded. " To bespeak praise, is forever to be disappointed of it; to fear it, is to deserve it; and to turn one's back upon it, is to be sure to have it follow."! But remember that only the praise of the praiseworthy is worth the acceptance. Who of noble aims, attaches any val- ue to the boisterous and senseless applause of the multitude at large ? This may satisfy the demagogue, but not the man of conscious worth. With him, Young. f Cronsax. 7 " One self-approving hour whole years outweighs Of stupid starers and of loud huzzas." It is the consciousness of merit alone, and of its full appreciation by those applauding, that can give expressions of esteem any attraction to the noble mind. And as only medical men can form a correct estimate of your future professional merits, the only medical reputation worthy your efforts, or which will give you any permanent satisfaction or advantage, is that which is founded on the respect and esteem of the most deserving of your professional brethren. This alone is the true medical eminence. Popularity, distinction, notoriety, may be acquired without it, or possibly in opposition to it; but not that fame which will do you honor while you live, and afterward still embalm your memory. I have said that the real elements of your future emi- nence are internal—that they exist within yourselves. It is but too often repeated that " circumstances make the man"—a proverb whose want of truth must certainly have precluded so general a currency, did it not supply to those who fail to secure the rank they have coveted, an explanation of their disappoint- ment so very gratifying to their vanity. Such instances as those of Sir Walter Raleigh, of Colbert, of Napoleon and Washington, have been gravely adduced in proof of it. But does any one really believe that the mere act of spreading his cloak upon the ground that his Queen might avoid soiling her shoes, would have raised a young man, independently of his mental qualifications, to the eminence Sir Walter subsequently attained ? In an unde- serving person, such gallantry would have received some slight token of acknowledgment, and then have been forgotten. What but the sterling integrity of Colbert while a poor errand-boy, was the prime element of his future renown as the greatest and best of the prime ministers of France ? And is it supposable that the same circumstances could have rendered any other individ- ual precisely what Napoleon became ? Can we imagine any cir- cumstances which would render any other person of different mental constitution and qualifications, either a Napoleon or a Washington ? Circumstances make the man as the microscope makes the animalcule it discloses to the eye. They are the me- dia or avenues through which true merit may become apparent. 8 They may also conduce to the development of powers, which else had remained latent, or but feeble. But this is all they can ac- complish. They confer no new powers; they make nothing. Mischief incalculable has resulted from the opposite belief. Young men have spent the best part of their lives in endeavoring to pro- duce the supposed favorable circumstances, instead of securing those mental resources which might enable them to mould any circumstances to their own liking. Understand me not to assert, that circumstances can have no influence upon your future eminence. But circumstances alone never have made, and never will make, a physician eminent who is destitute of merit. If there is any one circumstance which makes one eminent, more than all others together, it is the very last that is likely to be invoked by most, and the one most deprecated by those who believe in the proverb under considera- tion. It is poverty. But even this acts indirectly, by leading and often compelling one to acquire those internal qualifications on which his future eminence depends. On the other hand, nothing but a rare combination of opposing circumstances? and no one alone, can prevent one who possesses genuine merit from ultimately becoming eminent. These propositions are demonstrable by incontrovertible facts; and should induce every one of high aims, never to yield to des- pondence. Opposing circumstances may somewhat retard, pro- pitious may somewhat accelerate, your progress towards the goal. But if the true foundation exist within, it will in time be brought to light; when reputation will attach itself as surely as does the shadow to the substance exposed to the noon-day sun. If in ab- ject poverty, if cast friendless and alone upon the frigid mercies of an unsympathizing world around you, yet despond not. That world is needing, and waiting for, your best energies ; and will in due time, gratefully acknowledge them. " Yet bear up awhile, And what your bounded view, which only saw A little part, deemed evil, is no more. " Then will you discern that what is now a privation, and per- haps appears a sore misfortune, is in reality the greatest mercy you could have received; having secured for you that foundation 9 for future eminence, which the temptations afforded by wealth and other circumstances, considered favorable, would have en- tirely precluded. Does any one regard his own as a peculiar case ? Let him remember Roux, now for nearly forty years one of the best op- erators in France; forced to join the army at fifteen years of age, where his wages were but forty cents a month ; where his food was unwholesome, and never sufficient to appease his ap- petite; who afterwards was obliged by his rigid father to live on $120 a year while studying medicine in Paris, and never re- ceived a cent from him after obtaining his degree. Let him re- member Civiale, once equally indigent and friendless, and now equally well known—or Orfila, second to none in his own de- partments, who, a poor Spanish boy, was for years a second pilot on board a small coaster in the Mediterranean—or the erudite Velpeau, whose fame is as extensive as the civilized world; and who yet, when more than 25 years of age, was obliged to live weeks and months in Paris upon nine cents a day. I might mention scores of others who have attained to eminence in both our own, and other professions, whose early privations were equal- ly discouraging ; so true is it that intrinsic merit " makes a man " in spite of even adverse circumstances. With what incredulity would Velpeau have heard the prediction, if made to him in his garret 27 years ago, while poring over the works of the sur- geons of previous times, that ere now he would himself publish, to be circulated and read in all quarters of the globe, more than 30,000 pages of matter more profound than any of the works he then admired ? With no greater unbelief would any one of you hear the same predicted at this moment in regard to himself; and yet this has literally been fulfilled in him, while Velpeau is still as vigorous, and his pen as prolific, as ever. Doubtless poverty is a present inconvenience; but it is not a bar to eminence. " Not easily" says the Latin poet, " do those emerge from ob- scurity whose merits are eclipsed by poverty."^ But this very phraseology admits the possibility; and proofs accumulated are not wanting, that it is one of the most common events for those oppressed by the " res angusta domi" finally to excel those most favored by fortune. * " Haud facile emergunt, quorum virtutibus obstat Ro angusta domi ; 2 10 f proceed to specify some of the elements of true medi- cal eminence ; all of them being of a subjective character, as has been shown. The preceding remarks sufficiently imply a natural dif- ference in the constitution of different minds; each possessing its own original individuality. Certain mental traits are favor- able to future eminence ; others are altogether incompatible with it. Generosity and kindness are of the former class; cruelty and selfishness belong to the latter. But quite as great diversities are attributable to education; by which we may both secure those acquirements which lead to eminence, and moreover, to some extent, banish, or at least conceal, those natural character- istics which have the opposite effect. I. No natural peculiarities of mental character, however happily it maybe constituted, can secure eminence in our profession with- out a thorough medical education. I desire not to be misappre- hended on this point. In the earliest times, a comparatively small amount of acquirements might suffice; since that alone constituted all that was known of medicine. But in all ages, true eminence can only be secured by him who is thoroughly educated, according to the highest standard of his own times ; and far more learning is required now than even 40 years ago. The manner in which cases like those of Velpeau, Civiale, and Orfila, are frequently alluded to, would give the impression that these men, because they had been oppressed by want, emerged from obscurity and attained to eminence, by some other course than the prescribed one—the toilsome progress through a thorough education. But nothing is farther from the truth. In spite of want, and of a privation of privileges enjoyed by their classmates, these men acquired far wore than they, and thus laid the basis of a higher eminence. I need not specify the subjects, nor even the departments, which enter into a plan of a thorough medical education ; the former will be laid before you, during the course of instruction you are now pursuing. But I would insist on the importance of your at- tending to the minutest particulars in your medical studies, as well as the more general facts and principles. There can be no accura- cy, no thoroughness, without minuteness. Medical students are too much inclined to seize upon the showy and the attractive, 11 to the neglect of the less imposing details; to be pleased at first with the idea of becoming surgeons, rather than mere physi- cians ; and to think far more of performing operations, than of the minute knowledge on which is founded that far higher skill which cures instead of mutilating. Nothing should be regard- ed as too trivial to engage your studious attention, provided it be only truth. In the practice of your profession also, you will often find that the habit of attending to the slightest things, is of the greatest consequence to those under your care, and to your own reputation. Life may depend, sometimes, we know, not merely on what we may prescribe, but on a mere word or a look. " Trifles make perfection, and perfection is no trifle," said Michael Angelo to a friend, who inquired why he kept re- touching a face which to him seemed long before to have been finished. The smallest particles are removed by the lapidary's wheel; yet thus the rough and rusty mineral becomes the perfect gem. Merely invisible atoms are fixed by the daguerreotype ; and yet a perfect picture can in this way alone be produced. We can form no idea of perfection without minuteness. The public teacher has, however, only time to present the more prominent facts and principles : it is for you by your habits of minute inves- tigation, subsequently to perfect what you here acquire. Some are disposed to value themselves on the acquisition of mere mi- nutiae. But it is only in their aggregate that they become so im- portant to the perfection of your education. Your ambition must not expend itself upon mere atoms; but must repose on the vast structure of which they are to form merely molecular, though indispensable, parts. Small triumphs satisfy only small minds. Those only who enter upon their professional studies with a full sense of the dignity and importance of their profession, and the hope of contributing to its further elevation and advancement, can expect to secure the thorough medical education I have in- culcated. But if this be acquired, an exclusively medical educa- tion, however complete, cannot promise eminence. So manifold are the correlations of the various departments of medical sci- ence, that it would seem hardly possible for one to become a thorouo-h medical, without also rendering himself a very respec- 12 table general scholar. But we sometimes meet with men whose minds have been so exclusively occupied by medical subjects, that all others seem to have had, to them, no actual existence. But in the present view of my subject, it is a misfortune to know but one thing; however well that may be known. Far be it from me, Gentlemen, to abate, in the least, your professional enthusiasm. I would cherish it, to the utmost. But it must not be exclusive ; or it may render you much more ridiculous than eminent. The zeal of the French medical student,* who, on becoming affianced to the idol of his affections, testified his devotion by inviting her to go with him to see a woman he was dissecting, as the most delightful spectacle this lower world could present to her lovely eyes, doubtless seems a mere burlesque to most readers, f And yet a M. Rondelet of Montpelier, was so enthusiastic in his anatomical pursuits, that he actually dissected one of his own children; and entreated his intimate friend and colleague, Pontanus, when on his death-bed, to allow him similar liberties with his corporeal part, when no longer of use to its owner. Professional enthusiasm is indispensable; but it must be combined with general knowledge. It has well been said, " That which before us lies in daily life Is the prime wisdom. "— But when the poet adds— " What is more is fume, Or emptiness or fond impertinence ; And renders us, in things which most concern, Unpractis'd, unprepar'd, and still to seek "— lie must no longer be accepted as your guide. There is no kind of knowledge, which to a physician will become " fume, or emptiness, or impertinence." Each will find its appropriate place, and bring its peculiar advantages. Still it is the prime wisdom to understand our own profes- sion ; and we must not expect eminence in any other department of science or art. "One science only will one genius fit, So vast is art, so narrow human wit." We may, and should, aspire to a respectable standing in other * See Moliere. 13 departments; but to aim higher than this will preclude genuine eminence in our own. The elements of eminence differ in dif- ferent pursuits; and as we approach it in one, we recede from it in the rest. To become a truly eminent physician, is all any one human mind can reasonably hope to accomplish; and he v/ho thinks to do more, either does not appreciate what such em- inence implies, or greatly over-estimates his own powers. Most attain to eminence only in a single department of our profession, whether Medicine proper, Surgery, or Obstetrics; and some be- come distinguished—I would hardly say eminent,—in speciali- ties merely ; as is the case with oculists, and aurists. So Ru- bens, with all his power in imitating twilight scenes, could not delineate the female figure. But I would recommend a broader foundation for your future fame, than such enjoy. Lord Broug- ham's first rule of life has been, " to be a whole man to one thing at a time." This I would commend to you. But when you have mastered this one thing, proceed at once, as he has ever done, to another; never forgetting, however, that you are to shine, if at all, in your peculiar sphere. How entirely mistaken then, are those members of our pro- fession, who are ever grasping at honors foreign to their station; and with whom no distinction seems too paltry to be coveted. Such an one may now be found electioneering to secure a polit- ical, or even a military, office; next, striving, perhaps, to be the first on an unimportant committee ; then, parading his pretended knowledge of the mechanic arts, or of law, or of theology; as if he, forsooth, is intimately acquainted with all other professions, and is not confined to medicine alone. But all these efforts fail of bringing even an honorable distinction in anything. It was doubtless to secure the services of such a universal genius,— such a combination, as we often see developed in our own coun- try, of the demagogue, the pettifogger, and the theologaster— that the following advertisement appeared, it is said, in a European journal. " Wanted for a family that has bad health, a sober, steady person, in the capacity of Doctor, Surgeon, Apothecary, and man-midwife. He must also occasionally act as butler, and dress hair and wigs ; and will be required occasionally to read 14 prayers, and preach a sermon every Sunday. A liberal salary will be given." Many appropriate candidates for such a va- cancy do we see in our profession—Jacks in all trades, and good in none. It might be shown that the physician needs a general, in ad- dition to his professional education, far more than the lawyer or the clergyman ; and that more fail from the want of general, than of mere professional knowledge. But I pass to the second class, and to my mind the most important, of the elements of emi- nence, already alluded to. II. Thus a thorough medical and a good general education constitute the indispensable and only true basis of medical emi- nence. But my duty as a teacher ends not in inculcating mere- ly this. It is a still more important part of it—though too uni- formly overlooked—to remind you, that unless certain moral qualities cooperate, the highest merely intellectual culture will fail to bring you eminence at last. 1. A moral qualification of prime importance is a high sense of duty to our fellow-men. The physician must never forget that his peculiar mission consists in assuaging suffering, where- ever found, and without regard to compensation. " Aliis inser- viendo, consumuntur ipsi ; aliis medendo, moriuntur "__was applied to medical practitioners centuries ago. We have a rio-ht to expect compensation from those able to make it; but this must never be our primary motive, nor the condition of our efforts in others' behalf. But he alone can realize the claims of his fellow men upon him, who possesses a genuine tenderness of heart. The want of this trait is one of the strongest bars to eminence, whatever one's intellectual acquirements may be. There can be no true great- ness without it. Nor can its absence be concealed. Its effects are seen in all our words and actions, by those under our care • and secures in us a lively sympathy for them, and consequently our best efforts for their relief. It is appreciated especially by our female patients, as they detect it in the delicacy of manipula- tions abhorrent to them, but too often rendered necessary by dis- ease ; and often in a single kind word opportunely uttered, when another might have been silent. Frequently, "life and death are 15 in the power of the tongue" of the physician ; and none but the man of tender feelings can habitually make this organ an instru- ment of life. Few are fully aware of its power in this respect; too few realize how much of earthly happiness depends on the utterance of kind words to those aronnd us; nor how much is forever lost, from a habit of taciturnity in a man of benevolent feelings. The man of genuine tenderness treats all who confide in him, whatever their rank in life, with equal kindness. Such a man was Bourdon, the eminent surgeon; and such deserves your imitation. Cardinal du Bois, the prime minister of France, having sent for Bourdon to perform for him a difficult operation, said to him on entering, " Sir, you must not expect to treat me in the same rough manner as the miserable wretches of your Hospital, the Hotel Dieu." "My lord," replied he, "every one of those miserable wretches, as your eminence is pleased to call them, is, in my eyes, a Prime Minister" On the other hand, roughness of manner is directly opposed to the acquisition of eminence ; and actual cruelty is totally incompatible with it. None but the highest practical merits could have rendered Abernethy eminent, in spite of this power- ful obstacle. It has, however, singularly enough, been regarded by some as a prime element of his eminence. His rudeness has therefore been quite successfully imitated, by men who could never attain to a tithe of his skill; and with the result, uniform- ly following all similar experiments, of acquiring all his faults, without any of his excellencies or his fame. But even in him, this defect was tolerated merely because it was natural; when feigned, it excites only disgust. But tenderness, as truly as harshness, may be acquired to some extent, by those naturally deficient in it. Is it not well worth the effort ? 2. A noble and generous spirit is also essential to a recogni- tion of our duties to our fellow men. The selfish man can nev- er realize them; and never acquire an enviable distinction in his profession, whatever his talents may be. Whether selfishness display itself in avarice, arrogance, or any other form of mean- ness, the result is the same. The splendid anatomical acquire- ments of James Sylvius were completely eclipsed by his ex- 16 treme penuriousness; and while we hardly remember him as an anatomist, except from the incorporation of his name into that of a small muscle in the sole of the foot, his meanness is still promulgated in his well known epitaph by Buchanan. " Silvius hie situs est, gratis qui nil dedit unquam ; Mortuus est; gratis quod legis ista, dolet." Meanness of every kind is incompatible with true eminence. Lord Bacon has been justly immortalized by Pope in a single well-known line; but the other epithets, most forcible and lau- datory though they be, are more than counterbalanced by the single word " meanest," that follows them. A single mean ac- tion often forever destroys a reputation, above suspicion or re- proach up to the moment of its commission. How mistaken then, the man who would become eminent by arrogating to him- self another's merits; who would appropriate a discovery made by another; or take to himself the credit of a cure evidently owing to another's treatment! How utterly futile the hope of elevating himself either by depreciating others, or by vaunting his own success. The lion's skin he assumes will soon fall off, and then the genuine ass beneath is recognized by all. Every well-educated medical man well knows that circumstances which entirely escape his notice, may contribute to his own success; and that others, beyond all human control, may lead to a failure in another. Such a man, also, comprehends the actual difficul- ty and responsibility of medical practice; and, if he possesses a spark of generosity in his nature, he will cherish a charitable feeling towards all who meet with reverses, as he well knows must sometimes be the case, also, with himself. Such a man is never heard boasting that he has never lost a case of typhoid, or puerperal fever, or some other severe malady; though he has treated hundreds of such cases. For he knows that, even if he speaks the truth, better men have failed to secure equal success ; and therefore, he is probably far more indebted for it to his good fortune than to his skill—a very slender basis, surely, for self-in- flation. The straits into which men who pursue the opposite policy are sometimes driven, are sufficiently ludicrous. Some, on actually losing a typhoid patient, for example, gravely con- clude that he did not die of typhoid fever—no ! but of inflam- 17 mation of the brain, or lungs, or bowels, or of perforation; some one of which complications, as every tyro knows, is usually the proximate cause of death in fatal cases of this disease. Others, on such occasions, feel obliged to conclude that it was " Bilious " fever, and not typhoid, which the patient had. They had made a slight mistake in Diagnosis till the patient died; but death set the matter right. It was bilious fever ;for they never lost a case of ty- phoid in their life, or not for many years, at least. And the conclu- sion arrived at thus late, is announced with an assurance as ri- diculous as was the indecision of the loafer, who was pitched very unexpectedly through a two story window; and who, on picking himself up, and taking due time to make up his mind, gravely remarked that he "guessed he wasn't wanted up there." The spirit I am now commending, never condescends to affectation er duplicity. True nobleness needs no concealment, needs not to pass for what it is not, for its peculiar value con- sists in being precisely what it is. He alone affects to be anoth- er, who is conscious of not being already what he should be; he alone acts a double part, who feels that his usual course of conduct is open to exception. A man of noble and generous spirit will not flatter, for he delights not in the flattery of oth- ers ; while he who habitually dispenses it, is ever hoping to be repaid in his own base coin. The fawning sycophancy into which this trait sometimes degenerates, is in the highest degree disgust- ing : and as sometimes manifested by medical men towards their most influential patrons, finds a parallel only in the fellow mentioned by Martial; who, on hearing another say he was warm, would himself at once fall to sweating profusely.* A certain court physician, having advised the application of ice to the arm of a princess, to prevent inflammation, replied, on hearing her royal father remark that it would be very cold, " Certainly, cer- tainly, your majesty had better have it warmed, before applying it." This anecdote is the only remaining proof of hi3 eminence; and would you ever wish or expect to hear more respecting him ? Not such was the renowned Hoffman, in the presence of his despotic sovereign. " Sire," said he to the fierce Frederick III, on receiving abusive language from him, because he was unable at once to relieve him, " I cannot bear reproaches which *"Si dixeris aestuo, sudat." 3 18 I do not deserve; I have tried all the remedies art can supply, or nature admit; I am indeed a Professor by your bounty; but if my abilities or integrity are doubted, I am willing to leave not only the University, but also the kingdom ; and you cannot drive me into any place where the name of Hoffman will want respect." Which of these two court physicians, Gentlemen, shall be your model, in the particular respect under consideration ? If either fear or favor, can alone induce you to relinquish a well- grounded professional conclusion, bid adieu at once to all hopes of future eminence. The well qualified physician should regard himself as superior, in his proper sphere,—the sick room,—to every other person, of whatever rank or condition ; and let no consideration induce him, in a serious case, to adopt any other course than that which he judges the best. He must combine suavity of manner with his independence ; but he must not yield a rational opinion, without reasons perfectly satisfactory to his judgment for so doing. The conduct of Sir Matthew Tierney, in the peculiar circumstances in which he was called to attend George IV, will illustrate the principle I am inculcating. This monarch appearing to have merely a severe cold, his physician enjoined it upon him, on leaving him in the morning, that he should not on any account allow himself to be bled, before he saw him again, the next day. His symptoms, however, becom- ing more urgent, Sir Matthew, then a young practitioner, was sent for, and at once informed what directions had been left in respect to blood-letting. But he at once saw its necessity, and gave his opinion accordingly. The King objected, but the phy- sician was not to be moved. At length the former yielded, and his urgent symptoms were at once relieved. Sir Matthew's subsequent progress to eminence, was, doubtless, accelerated by this circumstance ; but we cannot fail to see, that the only part of the transaction giving the circumstance any value to him, was the manifestation of his skill, and of his independence of character. The physician of a noble and generous spirit, does not con- descend in his practice, to do things merely for effect—" ad captandum vulgus." Though there is perhaps greater tempta- tion to display in Surgery than in medical practice proper, it is mere quackery at all times , and to such claptrap, no man of 19 genuine merit will intentionally resort. It is often said that every thing goes by puffing now-a-days ; and hence there is a sort of necessity that every man blow his own trumpet, in self- defence. Assent to no such logic as this. It deserves only the contempt of a man thoroughly qualified for the high duties of the medical profession. Some of the best men in it have early in life, managed somewhat in accordance with the generally received ideas; but I have never known one subsequently to attribute any desirable results to this part of his experience. The community around us is not composed of such arrant block- heads as such a policy implies; on the contrary such trickery is, at once, generally understood, and brings only ridicule, in- stead of respect or renown. I need not specify the various pha- ses under which it manifests itself; from its mean and unmanly character it will I trust, at once, and in all its forms, receive your unqualified reprobation. 2. Another important moral element is a native modesty. As sympathy results from tenderness, so this is based on delica- cy of feeling; which is far more indispensable in the medical than in any other profession. Only the man who possesses this refinement of feeling can appreciate the embarrassments so often felt in disease by our most intelligent and refined female pa- tients ; only the man of genuine modesty will manifest his sym- pathy in a pleasing and acceptable manner. Coarseness and vulgarity are sufficiently disgusting in all circumstances; but in a physician, and above all in the presence oi female patients, they are unpardonable. Nor can a vulgar physician acquire or retain the respect of his professional brethren, more than of his intelligent patients. The want of true delicacy of feeling is usually sup- plied by such an amount of self-esteem,as precludes those studious habits indispensable to medical scholarship and skill; and moreo- ver renders him vainglorious and overbearing in his professional intercourse. The most highly educated physician, on the other hand, is generally found to be a man of unassuming manners and unobtrusive demeanor. " Much learning shows the little that we know "; while the self-confident, and forth-putting, never learn enough to enable them to begin to suspect their own igno- rance. But" a man's pride shall bring him low"; while "honor 20 shall uphold the humble in spirit." * The physician of refine- ment and true modesty, courts not the praise of men; but it fol- lows him, and that of women too, which is far better ; the boast- ing and assuming man is struggling for it incessantly,but never secures it. The former is frank and confiding; the latter is al- most uniformly suspicious—another development of meanness, incompatible with eminence. Understand me not, Gentlemen, to inculcate here that sickly sensibility and the childish timidity it engenders, which we sometimes detect in our professional breth- ren ; but that species of refined feeling which is uniformly com- bined with a thoroughly manly and decided character. A total want of this element of eminence, no amount of education can supply; though the latter may do much in preventing the devel- opment of the opposite qualities above mentioned. 3. Another indispensable characteristic is discretion, which also may be, to some extent, acquired. Some, however, cannot be rendered discreet, by any amount of education. Had Aken- side possessed this trait, he might have attained to the highest eminence in our profession ; though Swift contemptuously char- acterizes it as an " aldermanly virtue." But it must be dis- tinguished from mere cunning. The latter unscrupulously consults our own advantage, and is, in itself, low and contemp- tible ; discretion prevents us from unnecessarily injuring our- selves in the estimation of others, and is consistent with the highest moral excellence. It is based on a knowledge of hu- man character; which medical men, more than all others, both need and have facilities for acquiring. Indiscretion may, alone, neutralize all the intellectual and moral qualifications I have specified. It is manifested in actions, and still more constantly in language. All great talkers necesarily say some imprudent things. But the imprudent physician, even if not loquacious, is very sure to err in respect to certain particulars. A Diagno- sis will, usually, be delivered by the prudent practitioner in guarded terms, since he knows it is very often impossible to arrive at once at a correct conclusion; while he who lacks dis- cretion, will be very likely to give utterance to his first impres- sions in an unqualified manner. The former loses no credit, if he afterwards modifies his opinion; the latter leaves no way to *Prov. 29—23. 21 do this without losing the confidence of his patient. The form- er remains silent, unless directly questioned, till he becomes positive ; though he frankly admits he cannot form a satisfactory conclusion, if such an admission is called for. The latter be- comes positive at once, and must needs volunteer to express what he may soon be obliged to retract. In respect to Prog- nosis also, we discover a similar difference between the discreet and the indiscreet physician. The former is guarded in his ex- pressions ; the latter, positive. In cases of incurable diseases, however, it is the physician's duty, as soon as he is assured of the nature of the malady, unqualifiedly to declare its termination, to the friends of the patient; and, at the proper time, either through them or directly, as may be best, to the patient also. Some, I know, object to this rule of conduct; but among men of high religious character, I am not aware of any discrepancy of opinion. Having once given a Diagnosis or a Prognosis, the discreet physician, if he has occasion to repeat it, will constantly adhere, as nearly as may be, to the same phraseology. With all possi- ble precaution in this respect, people are so differently constitu- ted that he will, most probably, be often misunderstood; and without it, he will sometimes appear, to different persons, to have announced precisely opposite opinions ; and thus be thought either to have no decided opinion at all, or, what is worse, to have no regard for the truth. He also perceives an evident advantage in expressing his opinions in as few words as possible ; since the risk of being misunderstood is thus dimin- ished. He finds it equally important also, to use the plainest language; such as none can fail to comprehend. We some- times meet with physicians, who evidently believe that the con- stant use of technical terms gives their patients an overwhelm- ing sense of the profundity of their learning; while, in fact, all discriminating persons at once perceive that their big words are but a cloak for their ignorance. When two such physicians meet in consultation, a most ridiculous exhibition of bombast and mutual obfuscation occurs. It is a very safe rule not to use medical terms in our communications with non-medical persons. The most intelligent will often think us, at best, pedantic; and the ridiculous blunders made by the ignorant in quoting our 22 language, will raise a laugh about as much at our own expense as theirs. We are not seldom tempted to use a technical term to meet a question we prefer not to answer; but this is equally unsafe. It is more prudent either to decline an answer, or else to put it into plain English. I may give some amusing illustra- tions of these propositions, at another time. I need not remind you that the discreet physician never for- gets that he is bound not to divulge secrets disclosed to him in his professional capacity. In France this obligation has recent- ly been recognized even by the courts of justice; which cannot compel a physician to testify to facts implicating a patient, if they came to his knowledge in a professional way. Many a physician has lost the confidence of his fellow men by indiscre- tion in this respect; and too late has realized that " whoso keep- eth his mouth and his tongue, keepeth his soul from troubles."* The remaining time allows the specification of but a single moral element more. This is perseverance. Time is required for the acquisition of such an education as has been inculcated; and still more, to acquire that practical skill which is essential to practical eminence. Many young men of the finest talents have failed to reach the goal, from not being aware at the out- set of the length of the race. Let no fickle or faint-hearted man—no young man who expects soon to « complete his stud- ies," as we sometimes hear even young men speak of having done—ever expect to attain to eminence. Expect to study, ex- pect to labor, as long as life and health permit; or you will'nei- ther deserve nor can you secure it. But unless time be systematically and profitably occupied, its real value is lost. All our moments should have their ap- propriate labors, and not one be thrown away. " Sands make the mountain, moments make the year."f Lord Brougham's second rule of life has been, " never to lose an opportunity of doing anything that can be done." But the practising physician needs, more than any other man, to make the best use of his minutes, for he seldom has any leisure hours at all. And the amount which can be accomplished thus, in study or even in authorship, is truly astonishing; while no sa- orifice of rational or socidenjoymenls is required-nothing but "^Prov 21-21: fY^ 23 the habit of occupying in some profitable way, every moment which is not employed in professional avocations, and social en- joyments, or in necessary relaxation and repose. This habit accounts for the fact, that some of the most voluminous medical writers have composed their works while engaged in a practice apparently overwhelming. Velpeau has perused many a work, and composed many a page, in his carriage, while moving through the streets of Paris ; and the renowned Hoffman wrote so many medical works that their titles alone extend over no less than 38 quarto pages in Haller's Bibliotheca Medica. Very few young men have any idea of the benefit such a habit brings even in a single year. Yet the simplest calculation shows that a saving of merely ten minutes daily, amounts to one full hour per week; and in a year, to a gain of more than one week's un- interrupted study, of eight hours per day. Endeavor then, Gentlemen, to realize the immense value of your leisure min- utes; squander not the minutest fractions of your time. "Wis- dom walks before it, opportunity with it, and repentance behind it; he that has made it his friend, will have little to fear from his enemies; but he that has made it his enemy, will have lit- tle to hope from his friends." Possessed of the qualifications I have enumerated, you have a right to feel a confidence in your own resources, in any ordi- nary emergency. But you will not proclaim your own merits : " for men to seek their own glory, is not glory."* Nor will you encourage your friends to exert themselves in your behalf; "he that blesses his friend with a loud voice, rising early in the morning, it shall be counted a curse to him."t You will labor still more to deserve the high position to which you have the right to aspire ; and patiently and trustfully wait till time shall place you there. Should you be called to an early grave, your cherished hopes may not be realized by you ; but your example may still lift another from the humblest station to the pinnacle you hoped to reach. You may not in any event, expect to be- come as eminent as some who have preceded you ; for the standard according to which you are to be judged is raised, and discoveries and improvements become more rare, in proportion as your profession is elevated. But doubt not that if life and * Prov. 25—27. fProv. 27—14. health be vouchsafed to you, you will finally secure your appro- priate place in the estimation of your fellow men. 'Nor ^illyou foolishly despise small beginnings ; but remember that "before, -" honoris humility."* Sir Astley Cooper, who received more K v money for professional services, probably, than any one practi- tioner will ever receive hereafter, earned far too little to pay his expenses during several years of his professional career; and far less, I will venture to predict, than some of you will receive. Then labor on. Yield to no obstacle external to yourselves. The highest energies of which you are capable can be developed only by opposition. Be not oppressed by slander. "Envy doth merit as its shade pursue"; but should it aim at you its poison- ed darts, your dignified silence will prove a shield impenetrable to them, and turn them back upon the slanderer's head. De- spond not in adversity of any kind. " The good are better made by ill, " As odors crush'd are sweeter still."f But still toil on. You have the highest models in your profes- sion, both in past and present times, for your imitation; and " there is nothing which the human mind can conceive, which it cannot execute."$ Persevere, and secure the promised re- ward. But forget not still another element of eminence, which nought within you, nor around you, can bestow; which will sup- ply a natural deficiency of some of the moral qualities I have specified, and beautify them all; will be your support if all your hopes are blasted by disappointment, or even by an early death; and be the brightest star in your diadem, when human applause can no longer reach your ear. Perform your duties to your- selves, and to your fellow men; and you shall secure all that human esteem can bestow. But first, and above all, remember your obligations to Him who claims your earliest adoration. Then, whether early or late your earthly career may terminate, you shall at its close secure that prize, to which all human ap- plause is as nothing—which is reserved by a just and beneficent Creator for those who fulfil their mission here, " Heart within, and God o'erhead.'1^ * Prov. 18—12. t Rogers. \ Godwin. § Longfellow.