LECTURE INTRODUCTORY TO THE COURSE OF Institute anb practice of Hfebicitu IN THE MEDICAL COLLEGE OF THE STATE OF SOUTH CAROLINA. BY SAM'L. HENRY DICKSON, M.D., LL.D. CHARLESTON, NOV. 3, 1856. WALKER, EVAN8 & CO., STATIONERS AND PRINTERS, No. 3 Broad-street CHARLESTON, S. C, Nov. 4th, 1856. Prof. S. H. Dickson, M.D., LL.D.: Dear Sir,—At a mooting- of the Students of the Medical College of the State of South-Carolina, it was unanimously Rexolved, That a committee be appointed to solicit a copy of Prof. S. H. Dick- son's very eloquent and instructive Introductory Address, for publication. In transmitting the above, permit us to add, that your compliance with our request will be sincerely gratifying to ourselves personally, and to the members of the Class generally. Very respectfully, A. R. TABER, Chairman, J. C. FANT, R. Q. STACY, \VM. H. MOORE, I J. H. I'ACETTY, WM. H. DAUGHTREY, M.D. W. L. STEELE, T. J. VANCE, Committee. NOVEMBER 7th, 1856. Messrs. Taber, Fant, Stacy, Moore, Steele, Pacetty, Danghtrey, and Vance : Gkntlemen,—I ran make no other reply to your note, received to-day, than that I am ready to place at your disposal the Lecture so courteously asked for. With respectful acknowledgments to yourselves personally, and to the other members of the Class, I remain Your Friend and Servant, SAM'L. HENRY DICKSON. Hudson-street. LECTURE. The warmth of cordial welcome with which it is my impulse and pleasant duty to greet you, gentlemen! is tempered by an overshadow- ing consideration of the profound seriousness of purpose which brings us together in our present and future meetings. You have come hither to lay the foundation of your life-fortunes, to commence your history for time and eternity; to prepare for active enterprise; to fit yonrselves for the performance of the special duties to which you direct yourselves or find yourselves called; and to set out on a career of usefulness and benevolence. The thought of such objects and such a prospect as lie before you, should and must impress your minds with grave anxiety. For my own part I cannot but tremble to look upon my portion of the responsibilities involved in the relation that I hold to you as Teacher here, and Guide through the labyrinth of toil and difficulty into which you are about to enter. I cannot express to you the burdensome sense of what I owe to you, to your parents, to the community, and above all to God and my own conscience, under which I am ready to sink. When I reflect on the liability to error, which I cannot even hope altogether to avoid; the absolute impossibility of knowing all that is required to be known; the incurable uncertainty upon many important points; the tendency to be misled by the influence of unconscious prejudice and the bias of preconceived views; I shudder to think how much evil may be done in the position I occupy—how much good may be omitted, even with the aid of the most unremitting and conscientious efforts to escape the one, and to effect the other. And I am bound to confess to myself, and to warn you, that these acknowledgements are not mere generali- ties ; but that there are, probably in every such case, most unequivocally in mine, special and particular disabilities and defects, from which you are to be guarded. At the risk, then, of apparent presumption, and vainly seeming to anticipate more of your regard than I am entitled to or shall succeed in obtaining, I will entreat you at the very threshold, to 6 weigh for yourselves all opinions and views proposed to you ; to submit to no dictation; and on no occasion to yield either to me or any one else a blind or unreasoning confidence. Let me avow to you that it is my intention rather to teach you how to think than what to think; rather to lead you towards an apprehension of the truth, than to indoc- trinate you into any dogmas which I may have adopted. Each of you, it is to be presumed from your presence here—each one of you has set before him as his special aim, the acquisition of the knowledge essential to the Medical Practitioner; each one desires to become an expert, competent, and scientific Physician. I know not how I can better employ this first hour of intercourse with you than in an earnest endeavour to point out to you the best and most efficient means of attainment of this end. But let us first ask whether it is a worthy object of your ambition; whether there is in the character and course of the devotee of the Heal- ing Art so much that is desirable and elevated that one may without hesitation or reluctance dedicate his whole life, with all his powers of thought and action, to arrive at it. I answer most readily in the affirma- tive ; and declare my earnest belief that among all the pursuits of the human race, in peace or in war, in art or science or literature, no one can be found comparable to ours, either as to usefulness, beneficence, sublime self-sacrifice or wide and expansive intelligence. Where shall we seek the man who in these qualities shall vie with the true Physi- cian ! The darkness of midnight, the grey dawn of the misty morning, the heats of summer and the piercing cold of the wild winter wind find him ever abroad on his errand of philanthropy. In the foul raephitic gases of the charnel house, and amid the cries and groans of the hospital and pest-chamber has he spent the brightest, days and gayest evenings of his golden youth, to fit him for those offices which assimilate us to the pure nature of that Great Being whose all-absorbing attributes are kindness and mercy. Freely does he bestow all the combined results of his laborious studies, his educated intellect, the vigor of his manlv strength—all these he gives, and gives continuously, for the solace of the poor, the wretched, the afflicted. In the midst of pestilence, sur- rounded by the horrors of war, sharing fully the dangers of the soldier and the destitution of the miserable, his place is always—not for a brief episodic period of romance, nor in the transient indulgence of a generous impulse or a mere philanthropic emotion—but for life, his place is in the darkest nooks of social existence, endeavouring to let the sunshine in, and brightening their deep shadows with the soft tints of tenderest sympathy. You must not imagine for a moment that I exaggerate or 7 intensify in any degree the glorious function of the Medical Practitioner. On the contrary, I am humiliated at the feebleness of my attempt to describe or portray it. Yet, faint as is the picture, can any thing else be shown you so good or so lofty? Do not your hearts burn within you at the perusal of the record of what our Profession has done and suffered—■ does and suffers daily for humanity : its Promethean resistance against fate itself; its daring efforts to snatch fire from the very heavens to warm the chilled hearts of its brethren ; its familiar readiness to undergo every toil, all risks, and every form of want, to remove a burden or remedy an evil. We applaud—and justly—the martyr who dies for his faith, the patriot who lays down his life for his country. We admire—we cannot help admiring—the unflinching courage with which, at the battle of Balaclava, the gallant Six Hundred made their fierce charge upon the whole Russian army. Well may Britain be proud of this band of heroes! world-renowned, like the three hundred Spartans who fought under Leonidas. But compare them with the still more heroic Forty who fell at Norfolk. In blind, uncalculating obedience to a mistaken order—" Some one had blundered "—says the poet Tennyson; reckless as soldiers are and must be, both of present and future; swayed by the violent excitement of the moment: upheld by the long familiar military habits of subordination and associated movement; and acted on by the ever-stimulating inducements of reward and punishment, they plunged forward on an unavailing course of desperate daring in the transient fury of the combat. What honour and esteem, then, shall we accord to those our brave and noble brethren who perished in the pestilence that so gloomily afflicted our sister city of the Old Dominion, yielding them- selves a sacrifice worthy the smile of an approving Heaven, in the service of the unknown stranger, the sick and miserable of their fellow-men! In calm and silent deliberation; unheralded by " the pomp and circum- stance of glorious war "; surrounded by no sympathizing crowd; sustained by no false stimulus of passion, no vain hope of notoriety, no expecta- tion of reward or fear of punishment, they took their station where duty called them , and wretchedness and destitution demanded their presence; remained unshrinking at their post, and fell victims to disinterested benevolence. Animated and attracted by so glorious and delightful a theme, I have wandered for a moment from my immediate topic, to which I now return, and proceed to consider the elements which go to constitute the character of the true Physician. If you estimate this character at its proper value, if you regard it with the respect and veneration to which it is indeed entitled, you will resolve to spare no pains which shall be 8 necessary to make it your own. Let us enumerate and dwell briefly upon a few of the more prominent of these elements. The Physician must, above all other men, be diligent. Think how much is to be done, and recollect that we have but one short life to spend upon it. We engrave for eternity; let no day pass without its added line: " nulla dies sine tinea"; we have no time to lose. To raise a proper superstructure, the foundations must be laid deep and wide. Each step must lead on to another ; nothing is infertile; nothing transient; whatever is done, remains; we paint in fresco, the picture and the ground on which we lay our colours, hardening into stone as we paint. I do not know any individual more entitled to pity than a high- minded and conscientious young man, who, upon entering the ranks of our profession, finds that his early education has been defective, and that he labours under the heavy disadvantage which such deficiency must necessarily entail upon his whole life career. He will not be consoled, even by the thought that it is not he alone, or chiefly, who is to blame for this great error; that he is partly the victim of a bad system, and partly of an unjustifiable impatience peculiar or almost peculiar to our >i countrv, which urges to enterprise and action the immature adolescent before his faculties have reached their due development, and thus denies him the reasonable opportunity for requisite preparation and preliminary studies. He will find abundant consolation, however, in the reflection that it is never too late to begin a correct course—and that " nothing is denied to well-directed labour, though nothing is attainable without it", and in the fixed resolve carried out without delay, and with steady perse- verance, that he will comply with the requisitions of the contingency, and raise himself, step by step, to the lofty height he aspires to reach. "Take comfort, my son", wrote the illustrious Chatham to the no less illustrious Boy Minister, who so long governed the mighty kingdom of Great Britain, " Take comfort my son! after all, you have only the Cyclopedia to master ". The domain of Scientific Medicine reaches to-day over all the vast realms of modern attainment, comprising within its recognized limits an acquaintance with every department of human knowledge. "What science is there"—exclaims a recent writer on Physiology, himself an admirable example of omnivorous acquisition— "What science is there which is not involved in explaining our structure and functions ? Anatomy, Chemistry, Zoology, the various branches of Natural Philosophy, which themselves require as their foundation Mathe- matics", are briefly specified, but it would be difficult to say what could be excepted. Little less, indeed, than the complete circle so tersely indicated by 9 Chatham, will suffice for the Physician. " To learn to reason, he must know ". Knowledge is conveyed and bound up in language. Classical learning, therefore, and what is called literature, are necessary for him as truly as science proper, that he may understand what he reads, and be capable to state, to narrate, to infer, to argue, to prove, to convince. Modern languages are indispensable to him, if he aim at the highest point of excellence and its prompt attainment. It is mortifying to be compelled to wait for translations; and still more, to depend upon others not only for the selection of what they choose to distil for us from foreign materials, but for the correctness and truthfulness of the convey- ance. I am aware that "all is not possible to all", nay, perhaps not to any; but I am anxious^o impress upon you the urgent demand that you should attain to all that is possible, each one for himself. It is infinitely easy to know too little; infinitely difficult to know too much ! Besides, each one has his peculiar or special aptitudes, which he will never discover, nay, which have no means of development, but through diligence, patient study, vehement mental effort. As in a course of gym- nastics we find ourselves, upon earnest and repeated trial, capable of feats of strength and agility unthought of and unhoped for, so I will venture to assure you that the steepest and loftiest heights of the appa- rently impossible are often—and sometimes with unexpected ease too— scaled by the resolute climber. Forward, then, and be your motto, Excelsior! If your preliminary education have been imperfect, take up again, with manly determination the grammar and the dictionary. Master your own glorious tongue, the language of Milton and Shakspeare and Bacon—of Sydenham and Cullen and Rush. Enable yourselves to com- municate your thoughts in the fixed and stereotyped—not dead—but emphatically living and immortal dialect of universal science employed by Cicero and Pliny and Celsus, Stahl and Gregory. Open with familiar key the new and daily multiplying treasures accumulated by our French and German brethren, and it is impossible for me to exaggerate the advantages and facilities which will accrue to you from these highly available sources of intelligence. The Physiology of the present day—which the sagacious Draper has laboured to place among the positive sciences—its Pathology, its Diag- nosis, its Therapeutic, are peremptory and exacting. The immense resources of Chemistry must be brought within your reach—its univer- sally applicable principles, and at least so much of its minute details as belong to the relations of organized substances to each other and to the agents that surround them. Here there is nothing constant but change. Progress is perpetual. The truth of to-day is proved to-morrow to be 10 error; yet it is fruitful error leading on to further and perhaps more fertile error, and still further at last to truth. Encircled and sometimes narrowly circumscribed by the quid ignotum all around and about us, the small area of uncertain light almost buried in the all-enveloping darkness, we feel our way from point to point, ever hopeful and undis- mayed, because ever and anon sure to be gratified by some new acquisi- tion—some new foothold from which again we start on our ennobling career of unceasing advancement. Of all conquests possible to mant this triumph over ignorance is doubtless the most elevating. Physiology, as I said above, is now taught as an " exact science ", and the methods of positive Philosophy are introduced into our Pathological investigations. But these methods, to be successfully pursued, require much mental training. Empiricism is now denounced; conjectural views no longer admitted; our deductions and inferences must meet th^ demands of a rigorous logic, and the phrases we employ must offer pre- cise and clearly intelligible meaning. What purports to be doctrinal, must be rendered distinct and palpable, and susceptible of proof or dis- proof. Accustom yourselves to writing. Studium sine calamo, somnium. Make notes of your cases. If they present points of marked interest, prepare these notes for publication in some neighbouring or favorite Journal. While thus adding, as you are bound to do, something to the general mass of information, you will render your own conceptions more exact, and apprehend more clearly your own views. We think in words— and it is a matter of more importance than is generally supposed to attain the capacity and habit of embodying our thoughts in the proper and most correct terms. The want of this power is often felt in a most mortifying way by those who are reluctantly forced to the unaccustomed effort when called upon as witnesses, or to pronounce a professional opinion in a Court of Justice. Never leave a bedside without qualifying yourself to give in good set phrase, a graphic description of the case before you, in all its important points. " He who conceives any thing distinctly, will be very apt to express himself clearly concerning it"—and conversely, he who brings himself to describe anything clearly, will be found to have a distinct conception of it. The Physician must be observant—alert—awake—apprehensive. Our ancient Christian Church, like the Jewish priesthood, has ever demanded, that a candidate for offices and honors shall be perfect in all his senses, and of full physical as well as mental and moral capacity. This require- ment is as peremptory in our profession: the sana mens in sano corpore equally indispensable ; nay, if possible, even more so. 11 The vision of the practitioner must be keen : he must watch every expression of feature, every change of complexion—must detect all variations of external form and structure—must appreciate the nicest differences of colour and appearance in the eye, the countenance, the skin, the tongue. He must hear acutely, and apprehend promptly all normal and morbid sounds—the breathing, the voice, the groan, the cry : all are significant. His touch must be nice and delicate; susceptible of all changes of temperature, harshness, and impulse or movement. His olfactories must be capable of ready impression; many diseases and their conditions are as well and clearly defined by the odours associated with them as in any other way. I am as confident of my appreciation of the special effluvia in fully developed cases of Yellow Fever, Scarla- tina, Small-pox, and several other forms of disease, as of the rose, the apple, the pear, or the strawberry. Without correct gustation he cannot or should not practice Pharmacy, or prescribe and prepare prescriptions; it is only or chiefly by their peculiar flavour and taste that we make ourselves sure of the purity and proper condition of many medicaments. But however well gifted naturally any one may be in all these respects, he must still cultivate and educate the senses. He must learn " how to observe " ; he may select special objects of attention in the several cases, but he must omit nothing in any; he must every where and at all times observe. He must teach himself the habit of constant and ever active attention. He is not permitted, during the performance of his duties, to indulge in a moment's abstraction or absence of mind ; it may cost his patient's life, or his reputation. If careless or inattentive, the most palpable phenomena might escape him ; if properly scrutinized, nothing will elude his research, and he will be rewarded frequently by the most important and decisive discoveries of truth. Let him take a lesson from the wary savage, and the still more astute pioneer of our western prai- ries and forests; who are ever engaged in remarking upon every thing around them in air and sky and on earth, and owe their safety to this habit of keen observation. I need not dwell upon the importance of the education of the senses in their artificial or scientific applications—as in the use of the lens, the speculum, the stethoscope; but beyond this, in all the ordinary modes of inquiry and examination, we may thus render them far more susceptible, more available and more trustworthy. Inferences are drawn from pec- toral sounds of varying character, pitch and intensity, which require a musical ear—that is, an ear which has been taught to appreciate musical sounds as such. The touch especially admits of improvement, and may be rendered exquisitely available by properj^rotection and managements 12 of the tips of the fingers, which when rendered callous by exposure or rough use, are unfit to feel a pulse; to palpate the throbbing chest or the distended abdomen; to press, for examination, a tumor of doubtful character ; not to speak of their clumsy unadaptedness for the obscure investigations of obstetrics, or the grave manipulatipns of surgery. I will say nothing of the obvious disability of the deaf or blind or near- sighted ; but surely we should not expect the decrepid, the feeble, or the unsteady to sustain the fatigues and exposures, or perform duly the arduous labours of the profession. As life advances, indeed, all men become frail; but the old have gradually attained, as a sort of compen- sation for physical failure, an amount of experience which renders them valuable to their younger brethren as counsellors, and they may in this function be greatly useful, even under the pressure of much infirmity. It is well known from the statistics of Caspar and others that, of all the Professions, ours is the shortest lived; nay, there are very few among the most insalubrious occupations of mankind, that so much tend to render life so unhealthy or cut so abruptly its brief thread. The strongest constitution must succumb under the perpetual wear and tear of mind and body. A phlegmatic or selfish man may resist longer; the tender and sympathizing soon sink beneath the repeated agitation which attends on the tragedies of real life—far more impressive than the most highly wrought scenic representations—so constantly recurring within the expe- rience of the medical practitioner. Grief and joy, hope and despair, in their deepest intensities, present themselves ever and anon alternately before him, and he becomes inextricably involved again and again in the most critical and trying anxieties. These shocks which happen, it may be, as rare occasions in the lives of other men, affect him more or less nearly at brief intervals and unavoidably. Nothing is more fallacious than the common opinion that this frequency tends to harden the heart; to anneal the sensibility. On the contrary, it is my faith, and I avow it as my experience, also, that the feeling of sympathy grows stronger with each advancing lustrum; and that as our clients grow older with us, they and theirs—to the third and fourth generation—become more and more dear to us, and entangle us more and more closely, so that their griefs and sufferings and deaths affect us as if they were of our own flesh and blood. Exceptions are said to exist, and these are regarded by the crowd as the rule; but for my own part, I know of none such. My old medical friends, upon whose heads, as upon mine, time has strewn his ashes, are all of them like the Douglas of Scottish poesy—'" tender and true ". Let me not be told of practitioners who have, under all the disabilities 13 that I have spoken of, become highly useful and esteemed, and have attained eminence and wealth. Some such I have known ;—some have won my respect—and in exact proportion have excited in me sentiments of regret and mortification. I have lamented to witness the palpable mistakes of a half blind, though most intelligent physician, and his enforced submission to the leading of a stupid nurse; I have been a sorrowful witness at a visit in which a deaf physician maintained a con- jectural conversation with a debilitated sick man, who exhausted himself in vain efforts to make himself heard and understood. What shall we say of other forms of impairment, often the result of disgraceful and injurious habits, occasionally so artfully concealed or disguised—the uncertain touch, the unsteady hand, the vaccilating direction, the defect of voluntary control, bodily and mental. It is enough to hint at all these unfortunately now and then to be encountered, to induce us to reaffirm that the practice of our Profession requires the absolute completeness of the entire man, and that he who aspires to the character of the Physi- cian must be lltotus, teres, atque rotundus". The Medical Practitioner should be self-reliant. A certain decision and force of will is indispensably requisite in all situations which involve responsibility, and demand prompt action. The sailor in a storm, the commander in a battle, must in every emergency decide at once or perish. But such emergencies occur to us daily, as matters of course, in which the well-being, perhaps the lives of our patients and our own reputations are at stake. He who finds himself deficient in readiness or nerve in a crisis, should seek employment elsewhere than in our ranks. The Physician should be sceptical—a doubter—slow to believe. Cre- dulity has ever been, and still is, the prevailing evil among us. We are overwhelmed all the while with what Cull en calls " false facts". We lay hold of the apparent and assume it to be real. We are perpetually led astray by coincidences—post hoc, propter hoc. Hence the thousand notions of cures, remedies, specifics, antidotes. Hence the thousand forms of empiricism in and out of the regular body of practitioners. The very language we use is corrupted thus, and we no longer " take care"—curo-curare—of the patient, but we cure the disease, as if by magic art;—jugulate the abstraction, remove or counteract or neutralize the supposed cause. A volume would not suffice us to illustrate, as I might, this vicious propensity. The practical exaggerations of the ad- ministrators of digitalis and cod-liver oil in Phthisis—the decline of ancient and prevalent modes of treatment in the most common ailments, as of the lancet and antimony in Pneumonia, of mercury in Venereal disease and in Fevers; and the substitution of the expectant or the 14 stimulant for the heroic and depletory in so great a number—the tem- porary and local reign of Brunonian and Broussaian views—the perpetual differences between the best authorities as to the nature and modes of causation of our most familiar maladies—the mistakes in Diagnosis so often made by the most confident and dogmatic—and the unhappy uncertainty and feebleness of our Therapeutic in so many of our most fatal diseases—these may serve as examples. I will offer you a word of advice as to this matter. Do not admit the dependence of any malady upon any alleged mode of causation, until a wide variety of conditions shall have been inquired into. There may be more causes than one; or one may be extensively diffused. Do not admit the efficacy of any remedy in any disease, until it is ascertained whether it is absolutely or conditionally relevant;—whether it may not be dispensed with, and whether its apparent influence may not be a mere seeming coincidence. Time would fail me if I were to go into the further details as to the scepticism necessary to guard you against the self-delusion of the hypo- chondriac and the imbecile, the arts of the cunning actor or actress, whose inscrutable motive leads to an exultant deception, and the man- agement of the interested malingerer. Be ever on your watch against these: doubt every thing;—scrutinize everything; cross-examine and test every thing. Truth alone can stand the close inquiry. Above all other men, a Physician should be courteous. Politeness, an artificial necessity of civilized society, is with us an indispensable quality. I lay the more stress upon this point because a mistaken notion has become in some measure prevalent that an eccentric rudeness has tended to the success of certain distinguished practitioners. Let it be clearly understood that these men succeeded, not because, but in spite of their egregious defect. A gentle tenderness, a soft kindness of speech and act, are due to suffering humanity, and must be accorded. " To break the bruised reed "; to trample on the bowed down and afflicted; to fret harshly the sensitive; to abash the timid ; to insult the lowlv ;— what can be more unworthy of the man, the gentleman, the Christian, the philanthropist! Nothing can excuse or even palliate such conduct. He who indulges in it, under whatever plea of eccentricity or humour, is a brute or a madman, and totally unfit for a place among us. Some minor points may perhaps merit suggestion. Thoughtless dis- regard of the slighter annoyances to which we may subject our patients is inconsistent with the nicer degrees of gentlemanly propriety. We should pay some regard even to fastidiousness and prejudice. I would not willingly offend a delicate fine lady by approaching her with clothes and hair reeking with the fumes of tobacco—even supposing that there 15 was no risk of palpable annoyance by disturbing an unsettled stomach ; nor a sincere advocate of " Total Abstinence ", by breathing near him the odours—not in themselves disagreeable—of wine or alcoholic mix- tures. So, also, I would, jn conversation, exert all due forbearance as to what I considered the weaknesses, the follies, and even the more serious errors of those who had confided themselves to my transient guardian- ship. Nor need I dilate a moment upon the peremptory enforcement of courtesy to each other, without which the Profession cannot and ought not to retain for a day its own self-respect or the respect of the commu- nity. The most precise etiquette, the most formal ceremony, must be preferred to negligence here. Let us hope that the Southern physician will always be as he has hitherto been—distinguished for this high quality, even among Southern gentlemen. The Physician should be truthful—and in this matter, I make upon him a most difficult requisition. So much falsehood enters into our conventional life at the present day, that it becomes a really nice ques- tion whether truth itself is not sometimes the best instrument, the most skilful method of evasion and deceit. How am I now ? asks a firm and intelligent sick man. You may perhaps tell him without injury that he is very ill—in serious danger; but if the same question be put to you by an alarmed, desponding patient, in whose condition slight agitation may increase a risk already grave and imminent, you will hardly venture a similar reply. What, then, is to be done I Let me advise you. Never answer falsely—never deceive. This rule is absolute; I cannot modify it. Refuse to reply under any circumstances in which the only alterna- tive is falsehood on your part, or injury to your patient. You may, however, escape being driven to such an alternative. Commence your professional career by assuming from the very first a proper and reason- able degree of reserve and reticency, and you will thus protect yourself against such painful emergencies. Begin by meeting the inquiries and cross-examinations to which we are perpetually subjected, with the confession of both general and special fallibility of judgment, and the determination to form and deliver no hasty opinion. You may then be silent as long as you please, and speak when you think proper. This is your unquestionable privilege, and will come to be known as your habit. If, then, you exert a due degree of self-command, your patient's tendency to dangerous agitation will be efficiently repressed by your equable manner; and remember, that to govern or control others, it is indispen- sable that you should control yourself. A grave cheerfulness is the best aspect under which a physician can present himself in a sick room ; nor can it be interpreted as deceptive, even amidst the most melancholy 16 contingencies. He goes thither as the apostle of hope, of trust, of sym- pathy, of comfort, of relief. He cannot entirely fail, happen what may. His mission is never altogether barren of good results. It is his happy and glorious office to soothe irritation; to subdue violence ; to tran- quilize excitement; to diminish suffering; and in the effort itself to effect » these purposes, is found an infallible source of consolation. There are so many modes in which the Physician is tempted to false- hood, that it would be impossible to enter into detail on the subject. One or two of the most familiar may be noticed. We are often entreated to equivocate so as to conceal or to acquiesce in the denial or concealment of a disease reputed contagious, where its announcement would be incon- venient or injurious. In analogous instances, where some definite local cause of disease exists, or seems to exist, we are solicited to suppress the fact, or to employ, in speaking of it, some word or phrase conveying a false, or at least an evasive meaning. Thus—Scarlatina or Measles breaking out in a boarding school or hotel; Malarious Fever assailing a house, settlement or village regarded as healthy; Yellow Fever, or other pestilence, invading one of our commercial cities—every one knows, or will know, the odium incurred by the unfortunate physician who feels *" himself called on to report their existence. In all such contingencies as these I have only to repeat, you must speak the truth, if you speak at all. But it is made a question whether you are always bound to speak; and I readily acknowledge the plausibility of the grounds for advocating silence. The hope of extinguishing the evil in its incipient stage, and the certainty of ill consequences following announcement, these are the strong persuasives to a wrong course here. Do not permit them to lead you astray. Be careful to know the truth clearly : avoid haste in seeking for it; but as soon as it is known to you, it becomes incumbent on you to communicate it frankly and fully to all who are interested, and there- fore entitled to the information. Do not shrink from the consequences. A brave and conscientious man disregards them; an intelligent man knows how apt they are to be exaggerated by our fears, and how much more is threatened generally than will occur; besides, that there is always a large account upon the other side not taken into consideration. If we suppose a city to succeed in suppressing the notice of a grave epidemic within her limits, and thus keep up for the time her commer- cial activity, it cannot, I think, be reasonably doubted that the loss of life and ultimate loss of character which she would sustain, would vastly more than counterbalance the present injury accruing from fair dealing. One of the bitterest consequences, too, of falsehood, is, that truth itself becomes an object of suspicion, and fails to gain the trust to which it is 17 entitled. For example: the daily reports of mortality from pestilence officially issued here in our own Charleston, indefensible and injurious like the gloomy tolling of the death-bell, unnecessary and unwise as I have ever thought 'them, but erring nobly on the side of frankness and friendly warning—these daily reports are taken all over the country, as I have had repeated and mortifying opportunities of knowing, as mere general statements partial and palliative, indicating only the direction in which the truth is to be found, and conveying but a mere modicum of a dark and melancholy reality concealed behind them. So will it be with your private statements at first. You will be supposed—as is too often the case—to have spoken only half the truth; until by perse- verance in open well-doing you establish the enviable reputation of uniform truthfulness. Remember, further, that this reputation can only be preserved by the careful safeguard of a thoughtful and prudent reti- cence. Thus, too, am I led to treat of the duty and obligation of secrecy— ever incumbent on the Physician. You will need all your tact and delicacy in regard to this matter. He does not keep a secret, who in any manner, directly or indirectly, announces his possession of one. The shrewdness of those who surround him will always, by cross-exam- ination,—as in Canning's famous game of "twenty questions,"—extract the very heart of his mystery, if it be known that there is one in which he is involved. To keep " the even tenor of his way", with no special affectation of distance or concealment, is the only method available, and this will fully suffice. Recollect ever, that the professional confidence reposed in you by patients is inviolable. Such is the rule sustained every where by all honorable men, and even by Courts of Justice; as in the instances of the lawyer with his client, and the priest with his peni- tent in the confessional. It is possible that exceptions may present themselves—but they must be of extreme rareness, and must be made by you upon your personal responsibility. If you commit a mistake here, you will fall under the scorn of all who know you; no one will trust or employ you ; and your place in the Profession will thereafter be beneath contempt. The Physician must be eminently social. Without this quality, he will never obtain that knowledge of men and of the world which is so essential to what we term tact, sagacity or wisdom. Without a wide and familiar acquaintance with affairs about him, including all topics of local and general interest, he cannot fill the office of confidential friend and adviser of his family patients—a function belonging of necessity to the Profession. He is a man, and ought to say with the Latin poet, and o 18 more emphatically than other men, "Nihil humanurn mihi alienum puto" / In this country he is a sovereign, born to govern ; by his educa- tion specially qualified, and therefore specially responsible for his opinions and his vote upon all political questions. Look around and see how many of our brethren are distinguished members of the corporate com- ♦ munities to which they belong; how many exert official authority as Mayors, Aldermen and Legislators. The first martyr of the Revolution— Warren—was a Physician: so was he who penned the first Declaration of Independence—Dr. E. Brevard: among the signers of Jefferson's noble paraphrase of it, we have an honored representative—Dr. Rush : we may boast of a Howe, who fought for Greece and suffered for the cause of liberty and humanity in a Prussian dungeon; who gives light td the blind and intelligence to the darkened and otherwise hopeless: and of a Kane who first proved the existence of a polar sea, and has elevated the American name by his devotion to science and philanthropy, and by his unexampled energy of self-sacrifice in the Arctic researches for the lost Franklin. But time would fail me in the attempt at a mere enumeration of the heroes of our profession, eminent in every collateral department of science, literature and living enterprise. It has been said of the Law, that it "is a jealous mistress, allowing no attention to any rival". Not so—thank Heaven ! with Medicine, so inseparably associated in its progress with that of every other science and every art, that he cultivates best her wide fields who has explored most extensively every domain of human intelligence. I have thus sketched for you, gentlemen, briefly, in a fragmentary way and very imperfectly, the character and qualifications of the true Physician, in order to point out to you how you may attain those envi- able and most desirable objects of an honorable ambition. Diligence; attentive observation ; quick and ready apprehension; a large acquaint- ance with all collateral branches of knowledge; a habit of logical reasoning and careful verbal expression; a grave reticency; a cheerful but dignified reserve; inviolable secresy ; courteous politeness; au unsuspected truth- fulness and open frankness, and sociability—these have been somewhat dwelt upon. 1 have said nothing—I surely need say nothing of the lofty requisites so fundamentally necessary, of character above reproach and pure from all taints of open immorality—personal freedom from evil and offensive habits—a self-restraint never betrayed into excesses—and an assiduous attention to all matters of business. One word, in conclusion, as to your conduct while here in the pursuit of your studies. "Just as the twig is bent, the tree 's inclined "—said Pope, prettily and truly. Be warned as to the facility with which at 19 your age habits are formed, and take care to fall into no dangerous customs. Your duties here should confine you for a few months—closely, though not with absolute exclusiveness, to the Lecture rooms, the halls of Anatomy, and the Hospitals. Your parents fondly believe that while absent from their presence and control, you are engaged earnestly and conscientiously in the acquisition of knowledge unattainable at home. For this they consent to lose the enjoyment of your society and your assistance in domestic affairs: for this they expose you to the tempta- tions always to be found in a large city—to the seductions of unfamiliar vice,—to the ready proclivity of ardent youth to imprudent and intem- perate indulgences. In the confidence which they thus place in your principles of obedience and virtue, every generous mind would and must acknowledge the strongest inducement to self-restraint; every tender sentiment of affection and gratitude must urge you to fulfil their hopes and wishes, and make you shrink from inflicting upon them the pangs of disappointment, or the unspeakable sufferings of reflected disgrace. For their dear sakes, then—in the sacred names of father, brother, sister and mother, let me implore you to avoid the haunts of destruction, which, like " the gates of hell, lie open night and day " for you ; to turn away from the enticements of unhallowed pleasures which will surely lead you to remorse and despair! And, when our course is ended, let us enjoy the delightful gratifica- tion of'restoring you to the arms of those who love you, with minds enlarged, elevated aspirations, bright hopes, pure reputation and unstained honour.