Valedictory Address, Delivered April 15, 1891, By J. JVL DA COSTA, JW.D., Idi.D. PROFESSIONAL ASPIRATIONS: VALEDICTORY ADDRESS TO THE GRADUATING CLASS OF JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA, Delivered April 15, 1891, By J. M. DA COSTA, M.D., LL.D., PROFESSOR OF THE PRACTICE OF MEDICINE AND OF CLINICAL MEDICINE. PHILADELPHIA: J. B. LIPPINCOTT COMPANY. 1891. PROFESSIONAL ASPIRATIONS. Gentlemen of the Graduating Class : The rolling away of years has brought round to me the duty of addressing you on behalf of the Faculty. For them, and for all, I congratu- late you warmly, as I congratulated your prede- cessors eight years ago, and tell you how deeply interwoven with our congratulations are the truest feelings of affectionate interest in your future. What is this future to be ? There is not one of those whom I address who has not some idea, some wish, regarding it. Let me, then, here speak as one who would gladly be in your confidence, feel with you, see with your eyes, examine your half-shaped aspirations, and put into language what you as men and as members of a great guild wish and expect. As men, I know, you wish what all men wish,-for friends, for esteem, for worldly success. Yet, if even all these were granted to you, you would not be satisfied, unless with them you had the approval of your conscience in your work. There will be dark days to you, as 3 4 PROFESSIONAL ASPIRATIONS. there will be joyous days; and in those dark days the feeling that you have done right, that you have striven manfully to the best of your ability, that no one has suffered whom you could have relieved, that no life has been lost which greater care could have saved, will be a joy. And the faithfulness and the care are not only of use to those in whose behalf they are exerted, but they also become a help to others, stimulating them to the same. Thus the humblest, the least gifted, may strengthen the resolves of the most self- reliant, the most gifted. One life reacts on another,-its good increases the good in others. "So others shall Take patience, labor, to their heart and hand, From thy heart, and thy hand, and thy brave cheer, And God's grace fructify through thee to all. The least flower with a brimming cup may stand And share its dew-drop with another near." Airs. Browning. But what will you wish for, what will you aspire to as physicians f Surely your first wish must be to maintain the high tone of the pro- fession. In this you can do no better than to imitate the past. The precepts transmitted to us inculcate gentleness, faithfulness, self-sacrifice, PROFESSIONAL ASPIRATIONS. 5 boundless charity. They develop the humani- tarian who works for the common good more than for himself. They frown down all attempts at secrecy, and make it a point of honor to give at once to the world any discovery by which the world may be benefited. They sternly, but justly, exclude from fellowship all who traffic in pretended exclusive knowledge, or who put a trade-mark on anything they may have found out. In this respect the tone of centuries is still the tone of the day. The republic of science is ideal communism: everything belongs equally to all. The high tone of the profession also demands respect for our patients and their feelings. There is no danger of this being carried too far. We look too much at life in its stern features to be impressed with affectations and fancies. We are accustomed to penetrate under the gay covering of our civilization and see the real, no matter in whom. We are not of those who look at life through rose-colored glasses. But we are in some danger of forgetting the mandate of a long line of men of honor concerning the sacred duty of keeping confidences and of not talking about what is laid bare to us through our profession. Every age has a characteristic spirit. The spirit of this age is very active. He comes in the form 6 PROFESSIONAL ASPIRATIONS. of a newspaper Imp, ubiquitous and of boundless energy and inquisitiveness. He absorbs every- thing, and is beginning to sway the doctor. He leads him to speak of details of the sick-room for publication which ought not to be divulged, the telling of which must always be highly disagree- able to those concerned, and is often dishonorable. Set your faces against this. Remember the well- grounded faith in the honor of the medical pro- fession, its old tone. Keep this from deteriorating. Reflect that if this base yielding to a desire for notoriety goes on, there will be something more to be dreaded than illness, and that, the doctor. There is another baneful result of this noto- riety-seeking becoming manifest, the rushing into print to give positive opinions on professional matters which from their very nature are uncertain or are still undetermined. Do not let us blame the enterprising gentlemen of the press for trying to obtain these opinions. It is for them to endeavor to get information. It is for the man who knows the obligations of science to abstain in his vanity bordering on insanity, or in his zeal for self- advertisement, from disseminating half-digested or wholly inaccurate knowledge. Envy not the newspaper doctor the speck of glory he seeks to obtain by clinging to the coat-tail of some dis- PROFESSIONAL ASPIRATIONS. 7 coverer, or by pronouncing opinions of the hys- terical order on famous cases which he knows only by report. He suffers in the estimation of those who can judge him best. His professional brethren and men of trained intelligence in other pursuits cease to place any confidence in him. And he is not a happy man; he has his own trials. Some startling progress has been made, or the illness of one of great renown is arresting the attention of the world. Pity sincerely the misfortune of the chatterer in science. The re- porter does not ring his bell, and, miserable man, the morning edition appears and his name is not therein. " Study to be quiet," says Holy Writ; and so it must be in all scientific matters. Their nature requires quiet, a still, serene atmosphere, a sober announcement of results, and the shunning of all sensationalism. An aspiration of every true physician is that the time may come when he shall have no incura- ble cases; when old age alone shall baffle him. Do not think that, especially in encountering acute disease, you will ever see the day when you can feel other than distress at what you know must prove, with the means of resistance which we possess, an unequal and futile struggle. The 8 PROFESSIONAL ASPIRATIONS. youngest of us who to-day holds his newly-won diploma will have in his first unsuccessful case no deeper sense of misery than he who has had the experience of half a century. I declare I have known men of wide learning and of great and tried skill who could neither eat nor sleep when contending with a dangerous malady. I have seen those who never flinched for a moment while anything was to be done, depressed and worn by the knowledge of the inevitable result. " Time makes it no better for me," I heard a Nestor of great renown, whose silvered locks covered the acquisitions of long years, and whose collected manners were proverbial, say, humbly. And time will not make it easier for you. How can it ? Can the time come when you will see without emotion a child suffocating with croup and be aware that not even an operation offers more than the faintest chance ? Can you watch placidly the horrible struggles of lock-jaw ? Can you witness without distress the gasping for breath in an organic disease of the heart? If you can, you had better leave the profession: cast your diploma into the fire; you are not worthy to hold it. The desire to see Medicine gain in potency and in power is the aspiration of all who long PROFESSIONAL ASPIRATIONS. 9 and work for progress in their art. The aspira- tions may be as dreams. Bnt every worker must be to some extent a dreamer and have ideals. When he has no scientific longings, when he ceases to give play to his imagination, he ceases to work. It is, indeed, astonishing how the aspirations, the dreams, of one generation have been fulfilled in others. The greatest minds must have been the keenest dreamers. May we not suppose that the Homer of Medicine, Hippocrates, dreamt? How could he, the pro- found thinker, the philosopher, living in the Athens of Pericles, with Sophocles and Aristoph- anes as his contemporaries, most likely as his friends, vying with Socrates in framing a system of ethics,-how could he, the Founder of Medi- cine, fail to let his imagination dwell on its future ? Is it not probable that when he first applied auscultation by listening to the sound of liquid agitated in the chest, he thought of how other sounds might be found to indicate the workings of internal organs ? Could he have looked to the early part of this century, he would have seen a young Frenchman, fond almost as himself of his own magnificent tongue, working incessantly at the problem until he was exhausted; he would have seen the gifted Laenncc, before his atten- 10 PROFESSIONAL ASPIRATIONS. uated frame gave way to the very disease he was fathoming, create and almost perfect the science which was the first step in making modern diag- nosis what it is. In the brilliant reign of Hadrian lived Soranus, who had been the tutor of Atticus. He devoted himself chiefly to the diseases of the female sex, and wrote the only complete treatise on the sub- ject which has come down to us from antiquity. His work, remarkable for its fulness of knowledge, shows him to have been something of an enthu- siast ; and we can think of him in his evening walks near the splendid walls of high-turreted Rome,--the altce mcenia Roma? that Virgil loved, -or returning from the Athenaeum, as wondering what were to be the developments following his labors and the instruments he had invented. Had his eye penetrated into the future, there would have appeared to him, standing on a platform in what would have seemed a most singular garb, but with features familiar, because as regular in outline as those to which he was accustomed, a youth with a roll in his hand, and, attracted by the look of genius in his face, he might well have wished him strength to carry out resolves that were to lead to immortality: " Macte nova virtute puer; sic itur ad astra." PROFESSIONAL ASPIRATIONS. 11 And that wish would have been fulfilled in the creation of a science that owes everything to him,-to him, Marion Sims, Jefferson Medical College, class of 1835. s One of the most striking events during the great siege of Metz by Charles the Fifth was the entrance of Pare into the beleaguered town. The soldiers of the garrison were suffering ter- ribly from wounds and illness, and longed for him in whom they had boundless confidence. By the connivance of an Italian captain, he eluded the vigilance of the besiegers and passed through their lines into the fortress. The good news spreads rapidly; the soldiers turn out voluntarily to give him a triumphal reception, greeting him with the cry, "We have no longer any fear of death, even if we should be wounded, for Pare, our friend, is among us." Escorted by them, he soon finds himself with the great com- mander, the princely, humane Guise, whose hand- some countenance is barely marred by the lance- wound through the head cured by Pare's skill, and who now receives him very graciously, being, as Pare himself quaintly tells us, " very joyful of his coming." It is not long before he is as warmly welcomed by the members of the bril- liant chivalry of France, who are sharing with 12 PROFESSIONAL ASPIRATIONS. their gallant leader the honors and the dangers of the siege, by Roche-sur-Yon, by Francis and by Rene of Lorraine, by Nemours, by the intrepid Conde, by the knightly Montmorenci, and he hears from their courtly lips the same sentiment, that they now no longer fear death, if it should happen that they are wounded. Scarcely rested, Pare began his beneficent labors, with what were then extraordinary results. In those hours of fatigue and danger, but of appreciated work, sensible, as he could not help being, of how much he was beloved and trusted, must he not have felt that the use of the ligature which he had just introduced, and the simple method of treating wounds by which he had replaced the barbarous dressings employed prior to his day, would have fuller development and lead to yet greater progress ? It has been so. The ligature received in John Hunter's hands new scope and application; and a highly cultivated, ardent searcher after truth is, by the introduction of antisepsis, making of surgery one of the exact sciences. He has shown that even of seemingly grave wounds there is not much account to be made. In compound fractures, almost beyond the control of the skill of all the surgeons of former times, in which even to within PROFESSIONAL ASPIRATIONS. 13 a few years the mortality ranged from twenty-six to sixty-eight per cent., antiseptic surgery has reduced the mortality to less than one-half of one per cent. Antiseptic surgery permits the brain to be laid bare and its diseased parts to be excised. Antiseptic surgery opens the ab- domen with impunity. Antiseptic surgery saves easily hundreds of lives where formerly one was with difficulty rescued. How Pare would have delighted in all this! In the great triumphs brought about by Lister's work he would have seen his own aspirations for an almost perfect surgery fulfilled. Conspicuous among the physicians of the seventeenth century, great among those of all time, is Sydenham. In early life an officer, one of five brothers who fought in the army of Parliament, he remained loyal to the memory of the Protec- tor, and his doctor's garb covered through life a soldier's love of action and decision. He brought us back to the near study of nature, taught us to look at it clearly, to derive our knowledge wholly from it, and he stands out in history the very embodiment of the insight and practical character of his race. He had but little respect for mere authority, and it is to be feared that, had he lived a hundred years before the time he did, he would 14 PROFESSIONAL ASPIRATIONS. have been cited with Geynes before the Royal College of Physicians for impugning the infalli- bility of Galen, and would not have recanted. To him everything was observation, experiment. He pointed the way for advance in our science, and happy would he have been if he could have seen the sons of his intellect and endeavor who, following in his path, have made Medicine what it is; for these sons are Jenner and Bright and Addison, and Corvisart and Andral, and Skoda and Frerichs, and the elocpient Trousseau, whose delight it was to quote him, and our own truth- loving Flint. To produce insensibility during which all pain is abolished and operation rendered possible has been from antiquity the dream alike of philoso- phers, of poets, and of physicians. But the articles used gave rise to only incomplete anses- thesia, or they were too dangerous in their pro- found impression. What was hoped for, Shake- speare expressed in "Cymbeline " No danger in what show of death it makes, More than the locking up the spirits a time, To be more fresh, reviving." Such hopes have been almost realized in the discovery of ether. The early settlers of the PROFESSIONAL ASPIRATIONS. 15 rocky shores of our Eastern coast who brought with them the laws and literature and science of the land they left, these sturdy colonists have, through their offspring, by this discovery alone almost repaid what an older civilization gave them. From New England, indeed, by the labors of a descendant of its hardy pioneers; from America, which proudly claims Morton as a citizen; from this land, while yet in the infancy of its imperial destiny, has been sent forth one of the greatest blessings ever bestowed on humanity, one which makes all peoples her debtor. Anaes- thesia is a discovery which has stilled-almost annihilated-pain; has changed the whole aspect of the surgeon's art; lets him succeed where before he dared not move in the attempt; makes, in fact, the previously impossible a matter of every-day achievement: it is a discovery so cumulative and so beneficent that only, in the language of the same great poet, " time shall bring to ripeness" its extent, and his own prophetic lines might well be applied to it: " Our children's children Shall see this, and bless heaven." But to return to the thoughts and the hopes of our day. The aspirations of the present are 16 PROFESSIONAL ASPIRATIONS. chiefly therapeutic. We are seeking with pas- sionate zeal for new remedies, for new methods of cure. There is everywhere investigation, ex- periment, faith in the result of research. This is, indeed, an aggressive therapeutic age, in which the proper critic still has a place, but in which the sceptic must go to the rear. Doubt, says Thackeray, is always crying Pshaw and sneering. The Pshaws are not now very loud nor very influential. We do not begin by doubting; we begin by doing and then sifting. Let us rejoice that such is the tendency. A thousand doubters would not make a Koch. Ten thousand doubters would not have formed a Lister and given us antiseptic surgery. It is recognized as the part of superior wisdom to try to do, and not to doubt without attempting first to do. "If you doubt, you must," says Aristotle, " doubt well." But to doubt well we must first work well. The work now in progress all the world over is immense. Radical remedies are being sought for and diseases are attacked which a few years ago we recoiled from as beyond even attempt at cure. Day by day, step by step, discoveries are being approached which are already casting their shadows across our path. They will be reached one by one. It is well that this should be so. PROFESSIONAL ASPIRATIONS. 17 If everywhere were light at once, we should be limited in our knowledge. As with the heavens, the darkness lets us see the stars; the sun would obscure them, if there were perpetual light on this globe. But it is becoming more than a hope that the time will be when very many diseases which are now incurable will be remedied, and more will be prevented. Surely this time will come. Whether it be to-morrow; whether it be while you are still in the glories of manhood; whether it be when the smooth cheek of the youngest shall have grown furrowed and seamed with old age; whether it be when you are no more, it will come; come it must, come it will in God's own time. Yet it is not only in therapeutic knowledge that Medicine is gaining and that aspirations are being fulfilled. In every department,-in the rec- ognition of causes of disease, in the discrimination of morbid states, in hygiene,-in all directions it is widening and broadening. More than ever it is showing itself a science which soberly, steadfastly, purely, seeks only the true and the good. More than ever its studies, illuminated by the glow of research and the steady light of reflection, are clearly manifest as those of a broad humanity, -a humanity which plunges into the infection of 18 PROFESSIONAL ASPIRATIONS. hospitals, which is at home in the abodes of sorrow and pain, which attends as constantly to the neglected and the abject as to the caressed dwellers in sumptuousness, to which the most forsaken never appeals in vain, and to which the distresses of all men, in all climes, and at all times, instinctively turn. In this great development, in these great aims, we must all endeavor to assist. You are now as much privileged, as much under obligation, to aid, as any one. Only let the fire of science burn within you as a vestal fire. If you do, it will not only benefit others, but will benefit you. When discouraged by drudgery and by long wait- ing for opportunity; when chilled and choked by battling with pretentious commonplace; when awe-stricken with the power of dense, invincible dulness, it will glow, if you fan it, and warm and cheer you. It has been kindled by a divine spark, and cannot go out while you are true and honor- able and keep it alive for pure purposes. One of the most widespread of our aspira- tions is that medical knowledge shall extend into all lands and the benefits of medical civili- zation be universal. And wonderful it is what is being accomplished. There are China and Japan instinct with medical life. It is not many PROFESSIONAL ASPIRATIONS. 19 years since that medicines were used in them similar to those landed by the credulous leeches of the darkest times of the Middle Ages. In some parts of these vast empires, indeed, pow- dered lizards and dried scorpions, and portions of potted tigers and elephants, are still neatly ranged on the shelves of the apothecaries as the most potent of their drugs. Dragons' teeth and bones are very highly prized. We find in the medical works of To Wong King* that dragons' bones effect so much that even our patent-medicine advertisers must be envious of the claims of this powerful agent; for it cures headache, stomach- ache, colds, dysentery, and irregularities of the digestive organs, increases the general health, and drives away ghosts. But how wonderful the progress in these lands in the last few years, owino' to the ardent zeal of those desirous of extending our medical culture and to the eagerness with which the study of scientific medicine has been taken up! Many of our standard medical works have been translated. China possessed last year one hundred and four hospitals and dispensaries erected on European and American models. In Canton alone a de- voted medical missionary, Dr. Kerr, has trained * Quoted in The Nineteenth Century, June, 1887. 20 PROFESSIONAL ASPIRATIONS. one hundred medical assistants, chiefly Chinese, and has in the past thirty-six years, with their aid, treated over five hundred and twenty thousand patients. The Japanese student is a familiar sight in all centres of medical learning; and Japan has advanced so rapidly that it has put us to the blush, for it has established a public laboratory for the analysis of chemicals and of patent medicines, and exacts that the proprietors of patent medicines shall present a sample, with the names and proportions of the ingredients, directions for its use, and an explanation of its supposed efficacy. In France and a few other countries alone is there elsewhere such protection to the public. One more professional aspiration I may men- tion. It is one born of the best ambition, and I hope it will be that of many of you,-to become a teacher. If you do, you will be but carrying out one of the honorable traits of this College. She has a gratifying record as the Mother of eminent teachers, and claims with pride her dis- tinguished sons on many faculties of the land. Great schools leave the impress of their teaching and the characteristics of their success; they have great traditions. If you lead a teacher's life, you must accept with it a teacher's duty. PROFESSIONAL ASPIRATIONS. 21 One of his duties is to hand down the best tra- ditions of medical life, and to try to do that which in time will add to them. He will, then, not simply instruct; he will do more, he will edu- cate. He must also foster investigation, and be himself an investigator. His love for learning must never weaken: when he ceases to be more than an elder student, he ceases to be fit to be a teacher. A teacher's work does not die with him. It lives long after, and may give great results. Voltaire says of Virgil that he was Homer's greatest achievement; Dante was Virgil's. In science, and in the teaching of science, we find the same. Medicine teems with instances. Boer- haave inspired Haller; Hunter, Jenner; Cullen, Rush; B retonneau, Trousseau. Through his pupils a teacher lives; the man passes away, the teacher remains in his pupils and becomes part of them. What a thought, that they, the lenient judges of his endeavor, the pledges of his aspirations ful- filled, the subsisting signs of his responsibility, transmit his life. What a thought, that through them he may influence action for more than one generation; that from his impulse may spring what is far above himself. What a thought, that the teachers live with those they taught. Mitchell, 22 PROFESSIONAL ASPIRATIONS. Meigs, Joseph Pancoast, the two Grosses, are still with us. Hushed are their voices; but as in a distant hamlet a middle-aged man is now anx- iously bending over the bed of desperate illness, with his resources almost exhausted, some fertile suggestion of Mitchell comes to him; Meigs has helped him only a short time before with wise counsel given in language not to be forgotten. In another place a surgeon pauses in the midst of an unforeseen difficulty, when, in that moment of doubt, he remembers what he saw in watching the wonderful skill of Pancoast, and the hands of the famed surgeon seem to move once more coming to his aid; or he recalls some concise precept of one of a pair of great teachers, enun- ciated in lucid, forcible language by the lips of the son, or by the powerful father whose only rival in clear exposition was his son. His teachers are again with him; they are helping him from the spirit-world. What a stimulus, then, all this is to him who has the aspiration to instruct. And when the hour comes that I shall lay down this robe of teaching, when the time arrives that I address you no more, there will always remain the thought-I say it in all humility-that I shall live in you. I shall be with you in your strug- PROFESSIONAL ASPIRATIONS. 23 gles, shall share with you your successes. At every bedside of distress, at every bedside of hope, we meet again. The teacher is insepara- bly joined to you, to all his pupils. Awful, ever- present responsibility, constant excitant to truth- ful, arduous effort; and happy he who has been so guided that he has never forgotten his re- sponsibility nor relaxed his exertion; that he has used God's gift of teaching for God's purposes. My friends, I must say no more. But I may not leave you without thanking you and your predecessors for the friendship of nineteen years, which has added so greatly to the brightness and pleasure of my life. May kindly feelings ever remain with you in the times that separate us, and may happiness and prosperity and every blessing, now and always, attend you.