TWO LECTURES 
ON THE 
Conduct of the Medical Life 
HY 
S. WEIR MITCHELL, M.D., LL.D., Harv. 
Member National Academy of Sciences 
ADDRESSED 
TO 
The Students of the University of Pennsylvania 
AND 
The Jefferson Medical College 
PHILADELPHIA 
UNIVERSITY OF PENNSYLVANIA PI? ;s TWO LECTURES 
ON THE 
Conduct of the Medical Life 
BY 
S. WEIR MITCHELL, M.D., LL.D., Harv. 
Member National Academy of Sciences 
ADDRESSED 
TO 
The Students of the University of Pennsylvania 
AND 
The Jefferson Medical College 
PHILADELPHIA 
UNIVERSITY OF PENNSYLVANIA PRESS 
1893 Such profits as may be derived from the 
sale of these Lectures will be devoted by the 
University of Pennsylvania Press and the 
Author to the uses of the Students’ House 
and Club of the University. bewares 
ON THE 
(Jonduct of Medical Isife. 
A great soldier was asked in my presence what was in warfare 
the most interesting thing. He said, “ Recruits going into their first 
battle.” What he thought as to the young soldier I feel whenever it 
is my lot to see a mass of men about to turn from the training of the 
schools and to face the grim realities of the physician’s life. 
Here before me are some hundreds of men in the morning of exist- 
ence. Where will the noonday find you ? And the evening hour, 
when labor is over, and, looking back, the conscience, undisturbed by 
new ambitions, shall make up the ledger of a life—will it leave you 
weighted with the debts of wasted chances, or rich with the honest 
interest of accumulated character ? That the veteran like myself 
should look with a certain sad curiosity at a group of young soldiers 
is not strange. Here are men of varied individuality, of unequal 
fortunes, of every condition of life—some for whom all their ways 
have been thus far made easy, some for whom life has been always hard. 6 
Here, at least, within these walls you have all had equality of oppor- 
tunity. Let me hopefully presuppose you one and all to have used 
with diligence the precious years of training. You have thought, of 
course, of what you want to win. You vaguely call it success—suc- 
cess in life. That may mean many things. You will get some things 
you did not want or expect. You will fail where you least look for 
failure. You will win what you never dreamed of getting. 
Glancing back over a career which has been, perhaps, one of 
exceptional success, I see that many things which I began by meaning 
to be or do I quite utterly failed to be or do. If any one had told me 
at the start, or a little later, that I should never reach in all my life the 
goal I early set before me—a professor’s chair—I should have been 
troubled, perhaps discouraged. That I should secure other prizes as 
valuable I did not—could not—see. That I should stand here to-day 
where once I hoped to stand as a professor, and should feel that the 
fate which deprived me of the chance to teach with the tongue wTas my 
best friend—ah, that indeed seems strange to me as I look back and 
recall the bitterness of defeat. 
And this is a lesson which in some shape all of you may learn in 
time. The moral of it seems clear to me : The great thing, after all, 
is, and ever will be, not what you win, but how you win it, or, in fact, 
how you lose it. The cup of the winner in a race means only that he 
was a little the better runner than a dozen; but the race trained all who 
lost as well as him who won. Is it not much that each got the honest 7 
best out of bis preparation ? The last in a race may be the truest win- 
ner, though a thoughtless crowd smiles at his lagging pace. 
In the great race you are about to run, the prizes which now seem 
to you the true ones are, I fancy, a great practice, the competence it 
should fairly secure, the esteem of your fellow-men, and perhaps the 
blue ribbon of the professor’s chair. But some of these are for the few, 
and sometimes for the unworthy. If conscience silently salutes }rou 
belated at the goal, and you know, with whatever added bitterness 
relative failure may bring, that you have done the best for yourself, 
with yourself, you will have won that which does not always go with 
the larger and more obvious successes of this mortal world. If, in a 
word, there be in regard to life largely looked at one thing which 
shines out clear and plain among its many riddles, it is that the making 
of character is the true and sure object of a rational existence. Fail- 
ures are of use if you iise them rightly, think of them rightly. If 
they make you lie down and give up, if they leave with you abiding 
bitterness and unmanly hatred of rivals, then are you so far ignorant 
of the nobler uses of defeat. And this is true of success. If he who 
wins a professor’s chair or a great practice simply declines into 
unthoughtful and languid use of opportunities, shall we think of him 
as having truly won the prize ? I have known men to whom failure 
was more valuable than success. I have known many to whom success 
was fatal, so far as growth of character or intellectual progress was 
concerned. 8 
Be sure, however, that I do not mean by what I have said to 
advise you not to have definite aims in life. It is a good, and not in 
any way an evil, thing to set before your young selves certain 
results which you mean to reach by honest use of all the means which 
time and training may put in your power. What Ido eagerly desire 
to place irrevocably in your minds is the belief that the means must be 
such as your best moments will approve. For then, whatever comes, 
you will at least be secure that your defeats or your victories are but a 
part of the loftiest education and a preparation for the higher evolu- 
tions of that other world where, as I trust, the life of effort may still 
go on with yet nobler aims and more secure results. 
All this may seem to you, who, young and hopeful, look out on 
life with confidence which, alas! the years to come may rudely disturb 
—it may seem to you much like a sermon. I can promise to be less 
dull and more minutely practical before we are done. But these are to 
be lessons in the conduct of the medical life. Back of all right con- 
duct must be a directing code or creed; and I could not ask you to go 
along with me into the consideration of the varied aspects of our work 
without making you feel with me how seriously I look at the life upon 
which you are about to start. Consider for a moment what it is. It 
is a profession, and not merely a business. He who looks upon it 
commercially, and only thus, is apt to fail of even the mere financial 
form of success, because it is the peculiarity of our mode of earn- 
ing a livelihood that it is not and cannot be regarded as a mere 9 
business. We know too well the merely mercantile doctor; but the 
more you study the lives of exceptionally successful physicians in all 
ages, the more clearly will you come to see that the brilliant triumphs 
have fallen most often to those who had the highest ideals as to what 
they wrere dutifully bound to give rather than what they were in return 
to get. lam fond of saying that in our work we sell what neither we 
who sell nor those who buy can weigh or measure. We have no public 
to which we bend with abject submission as does the lower newspaper 
man, most timid of the reptilia; no judge or jury listens to us; no press 
or public look on to applaud or condemn. What wre do neither the 
patient nor his friends can fully understand. One silent auditor makes 
up our moral accounts. That we live and are to live very largely a 
life of isolated self-judgment, that neither scale nor measure approves 
the amount and integrity of what we sell—this, I think, should make 
us doubly careful. I have no fear but that, as life goes on, the thought- 
ful among you will come to have a justified pride in your profession, 
and high standards as to what it should exact as to moral qualities and 
intellectual attainments; but too often the young start in life with 
vague ideas. I want you to go hence with unattainable ideals of what 
you mean to make your working lives; the higher the better. At all 
events, have and hold distinct conceptions as to the qualities which 
make men great in the higher manhood of medicine, and acquire them 
now. The world may make strange havoc with your views when, as 
years go on, you are to be guided by them in the every-da}r work of 10 
life. But he is to be pitied who when young having no ideals of duty, 
waits for opportunity to generate a code of conduct. 
There are risks to character already active in your lives. When I 
see men become easily indifferent to the exposures and the pains and 
suffering of the clinic and the ward, thoughtless of the falling shadows 
of the poor man’s death, brutal or full of levity when learning the 
secrets of man’s structure in the dissecting-room, then I know that 
evil has begun which insensibly hardens so many. For, while excess 
of sensibility destroys efficiency of action, and makes impossible that 
neutrality of mind which should go before decision, the other extreme 
is worse, because in our work you will more or less fail if you do not 
take into account the sentiments, passions, temptations and pains of 
men. He who becomes a mere hard mental machine can never justly 
estimate the enormous importance of the moral nature in its influence 
on the subjects of disease. Inattentive to such considerations, he 
makes no useful estimate of that individuality which makes the too 
definite text-book statements of symptoms but mere mockery; for, 
believe me, character tells in disease. The symptom varies with the 
human soil. Temperament is, as it were, a modifying climate. Where 
one man worries, another laughs. I could lecture long on this need to 
know men through earnest, kindly estimate of their moral as well as 
their physical peculiarities—the human climate and the human soil. I 
have been run away with by my subject; but if this should result now 
and hereafter in making and keeping you tender, and therefore gentle, 11 
I shall not have spent the cheap money of words in vain. Out of such 
thoughtful, constantly recurring estimates of the effect of pain and 
trouble on others comes that divine gift of sympathy which in some 
men rises into the capabilities of genius. A thing, this sympathy, 
to be honestly cultivated in youth and sacredly treasured in age. 
As I have urged, it has its intellectual values in practice, and helps 
also to keep the conscience active. But be careful not to affect sym- 
pathy where you have it not. There are commercial representations 
of all the virtues. Take care! Make-believe sympathy is a false coin— 
most easy of detection. I recall with amused pleasure a fine old 
Quaker lady who told a doctor she did not like her feelings poulticed. 
The early training of the doctor tends measurably to make us look 
upon man as a mere machine, on which we work with knife and saw 
and into which we cast with more or less thought our drugs. It is the 
fear lest you drift into this materialistic conception which makes me 
eager that you shall not quite lose touch of the feeling that the soul of 
a man dwells in this house of clay, and that forever you are dealing 
with an immensely complicated and ethereal thing, which thinks as 
well as feels. 
I have heard it urged that our humanely managed demon- 
strations on living things tend to harden the student and to take 
away from him that just respect with which he should regard the won- 
derful vital works of God. I can only say that when as a young man 
I first saw exposed so much of the machine of moving life as one may 12 
see—the bounding heart, the swift rush of blood through the capil- 
laries, the silent brain rising and falling with each breath—the effect 
upon me was then, and has been ever since, a growing sense of the 
awfulness of life. I trust that among you are many who have carried 
away with you a like sensation of the wonder and the marvel of it all. 
Out of that should come a keener perception of the vast complication, 
the almost hopeless riddles, of this strange machine, a man, and out of 
this again a vivid belief in the limitations of our knowledge and our 
powers, with, at last, such intellectual humility as ought to be his who, 
having learned all he can, knows, alas! how little are the counted gains 
of the long generations of our guild who have faced fairly this prob- 
lem of life. 
lam uneasily conscious of the gravity of all this talk. Its seri- 
ousness is but a measure of how earnest is my wish that you carry 
hence into your young careers a distinct capital of thoughtful, good 
intentions, and that these shall be founded on as clear conceptions of 
the finer qualities which in making the man make also the nobler 
doctor. We talk lightly of resolve, and say that the streets of a cer- 
tain place are paved with good resolutions. Be sure that the highways 
of honour and true goodness were never paved without them. A great 
poet, who felt the need of man to form in youth an ideal for the con- 
duct of life, has set it in verse which will live while men speak the 
English tongue : It is the generous spirit, who, when brought 
Among the tasks of real life, has wrought 
Upon the plan that pleased his childish thought; 
Whose high endeavors are an inward light, 
That makes the path before him always bright; 
Who with a natural instinct to discern 
What knowledge can perform, is diligent to learn, 
Abides by this resolve, and stops not there, 
But makes his moral being his prime care; 
Who, doomed to go in company with pain 
And fear and bloodshed, miserable train ! 
Turns his necessity to glorious gain. 
Might he not have been speaking of our own lives ? He is telling 
us what should be the soMier at his best; but great truths have many 
applications, and this high-minded poem is throughout a lofty state- 
ment of the moral laws which should mould and guide in the conduct 
of any life. Before I leave it, consider with me a moment its helpfnl 
maxim, that high endeavor is to us as an inward light thrown forward 
on the paths of duty, and making all action easier. The endeavor may 
fail, but it is light unto the feet. Surely no man who in time of doubt 
has made up his mind to abide by the loftiest moral purpose can have 
failed to feel the relief, the illumination, which such decision casts for- 
ward on the way of purpose. 
In an altogether admirable lecture on the man as doctor, the son 
of the greater Emerson has considered the influence of the doctor’s 14 
life on character. Let us also think of this a little. You all start with a 
certain capital of moral and mental qualifications. Growth of charac- 
ter is the best interest. The coarser gains will take care of them- 
selves. You may make some bad moral debts as you go along; we all 
do this. Try to know them as debts. It is best to be your own sharp 
creditor. 
Just as the first few years of childhood determine in their training 
the product of deeply-grooved habits of truth, industry, punctuality, 
good temper, and other minor virtues, as important to you are the 
coming years of the childhood of the medical life. Now is the time 
when readily-won habits, and the carefully-cultured use of mind and 
heart, help to make the life to come simple, and its decisions easy. Be 
careful what you do with these years. Let us look at some of the 
aspects they present. 
The world is quietly confident that we will care for the sick who 
cannot pay us. Was ever finer tribute to the creed of conduct of a 
vast group of men ? And it is among these poor your earliest work 
will be. But even this unpaid service, of which I shall speak again, 
which you ought to desire for experience sake, and, too, because it is 
wise and well to do so—even this will not competently fill your many 
hours of leisure. Now, what shall you do with these unfilled hours ? 
A time of peril—a time of moral risks. Believe me, the hours of obli- 
gation in life are scarcely so sharp a test of the man as those which we 15 
call of leisure. What he does with these latter, especially in youth, is 
the best means of knowing what the man is and what he will be. 
The difficulty is greater with the doctor than with others. To-day 
he is busy, to-morrow he is not. The time when he would read, or 
what not, is broken by sudden calls. I really think that to know 
how resolutely to use the minutes is one of life’s most valuable attain- 
ments. Take care of the minutes and the years will take care of them- 
selves. 
In great cities the young and but slightly occupied doctor has 
many resources; clinics, hospitals, dispensaries, lectures, may help to 
fill his hours; but even he has too much time. No one can or ought 
to study constantly; and probably his most valuable reading is in con- 
nection with his cases. 
But, whether in town or country, what shall you do with the hours 
still left at your disposal when the reasonable claims of exercise, study 
and social life have been provided for ? On your decision depends 
whether you mean to be merely a more or less well-running medical 
machine, or whether, with larger views of life, you desire to rise above 
the common levels of professional existence. All your life long you 
will have times, such as come to the busiest, when there will be leisure 
for other than professional work. Can you learn in youth to do things 
which will agreeably fill these hours? and can you continue amid 
growth of labor to do the like ? This seems to me a question of con- 
tinuity of energy. Plenty of men are good for a spurt, or even for long work; but that sustained power of industry which enables a man 
to use himself steadity in a variety of ways is in some measure a gift, 
and in some degree, I feel glad to think, an acquisition which he may 
successfully will to get. I have known several men, and one I know 
full well, who, being by temperament lazy, have become restlessly 
active, and learned the great truth that mere idleness is a less perfect 
rest, strange as it may sound, than variety of occupation. The out- 
come of my advice is to get some hobby and ride it early and hard. 
Those hobbies which lure a man out of doors are best; and in botany, 
mineralogy, or geology, according to your tastes and surroundings, 
you may find valuable resources. I know a railway president who is 
an admirable botanist, a half-dozen country doctors who are as good, 
two who are excellent mineralogists. Only, do something of the kind; 
for be assured that no matter what branch of natural study you follow 
it will have its advantages in making you a more competent student of 
the ills which should ever be and remain the ruling study of your life. 
There is a quite happy temperament which finds joy in mere simple 
observation of nature, and one which is pleasantly reflective in its deal- 
ings with the gifts of observation. I have ridden very many times 
long miles with country doctors, and been amused or instructed to see 
what use they made of their endless drives. Once, some years ago, I 
was asked by one of these gentlemen if I would like to go in the 
saddle from the station where he met me. The ride was long. I had 
sent him Dr. Emerson’s little lecture, and he quoted from it what 17 
Mahomet said of the horse : “ Blessings, success and rich gain shall be 
hung to the forelock of the horse till the day of resurrection.” My 
friend was disposed to take me across country, but this I declined. 
He talked of horses much, and rarely drove. ‘‘A horse,” he said, 
“ is your friend when you are on his back, your servant when he is 
pulling you.” This man was a mere lover of nature, and had a mind 
full of the oddest thoughts and reflections on the horses he loved and 
the changeful nature which bad become for him a pleasant chatty com- 
rade. He collected in his garden all the wild flowers, transporting 
their natural soil, knew the names of none, and talked to me ten 
minutes about the eccentric growth of a tulip-poplar he had known 
from youth, and how trees varied according to their soil and surround- 
ings. A plain, odd, direct man, this, and an able doctor. I asked 
him if he knew that wonderful text-book of the methods of mere 
observation of nature, Ruskin’s “ Modern Painters.” He said, “ No,” 
and I sent it to him. He wrote me that it was “ a great book, but a bit 
hysterical in places; ” and if this judgment makes you read it, you may 
agree or not, but you will find in it, as I have done, more of the art of 
simple study of natural objects than in any other volume known 
to me. 
I was once driving with a plain country doctor, also a quite old 
man, when he pulled up his horse, and, jumping out, returned with a 
flower. “ Ah,” he said, “that I never saw before; and I know every 
With our reflective people this type of mind is not rare. weed within an area of twenty miles, and I don’t know the name of 
one of them.” Presently he called my attention to a curious hyper- 
trophic growth on a fir-tree, a thick mass of tangled twigs;1 and so I 
saw that my companion was, without added science, a good observer—a 
man who sees. I found, too, as I expected, that I could tell him no 
new thing as to the case in which he had asked my counsel. 
This habit of active every-day observation is all the better for the 
methodical addition of science, but may well enough exist without it. 
It is, in fact, a quality which, strange as it may seem, few doctors pos- 
sess or sedulously cultivate. One man goes to and away from a bed- 
side, or talks to a chronic case, and sees and hears no more than the 
bare symptoms; another is curiously wide awake as to all his senses; by 
mere habit nothing escapes him; the patient’s expression, his room, 
his dress, his surroundings, all interest him, and some day he gets out 
of all this results when other men fail. A friend of mine on his way 
to a train in Milan was accosted as he crossed the court of his hotel by 
an American, who said; ‘‘You are Dr. Blank. May I consult you ? 
lam very sick.” My friend said, with a glance at his face, “ You are 
nervous and can’t sleep.” ‘‘That is true.” ‘‘Well, you smoke in 
excess, and chew. Quit it altogether. I have no time to say more. 
Good-by.” The bewildered patient obeyed the order, and, coming 
home, spoke widely—and he was a well-known man—of this acute 
diagnosis. When my friend was asked to explain it, he said : “ The 
lln middle Pennsylvania called a hurrah’s nest. But this phrase has also other applications’ 19 
man looked haggard; his hands shook; at the corner of his mouth was 
a slight stain of tobacco; in his waistcoat-pocket were four big black 
cigars. It was plain enough.” Yet how many men would have seen 
all this ? I could tell you other such stories, but one may suffice, as 
my business is not alone to amuse you. 
One man notices what he is called on to notice; another observes 
well enough with eye, ear, or nose, but fails to remember so as to make 
use of the magazine of stored-up sensations. People with senses always 
alert like sentinels are rare. I was once, at dusk of evening, long 
years ago, when a student of medicine, in an omnibus with my father. 
Suddenly he said to me, quietly : “It is curious; I have had a sensa- 
tion of something disagreeable which for a moment puzzled me. Now 
I know what it is. It is the odor of smallpox. There is some one 
near us who has it.” At the next corner a young man got out. As 
he passed us my father saw that his face was dotted with the quite well- 
formed eruption. We followed him out of the omnibus, and on the side- 
walk my father explained in a kindly way to the young man that he was 
ill, and with what manner of disease. He said, in explanation, that he 
felt sick, but that although fevered for some days he had not known 
what was the matter, and so had continued to work rather than lose his 
job. This little story illustrates the way in which the mind and observ- 
ing senses work automatically in the long and thoroughly trained. 
These remarks on the power to observe, on the education of the 
senses until they seem to work with ready certainty, have led me off 20 
the main highway of my thesis. Let us find the road again. I was 
trying to make clear to you that some out-of-door pursuit of nature’s 
ways was of delightful use, because the play of the mind trains for its 
serious work, and because these resources never fail to add to the 
happiness of life, and, so far as may be, to bring into an existence full of 
worries and anxieties that remarkable contentment which I have 
observed to be the best moral property of the naturalist. ‘ ‘ Care sits 
behind the rider,” was said of old—but not, I think, behind him who 
rides a hobby. I remember once, at my own table, my friend Leidy 
listening with curious attention to a man who said that life was tire- 
some at times, and that the thing which has no English name—ennui 
—was not rare with him. Leidy looked up with a smile of gentle 
sweetness which swiftly interpreted the man. “ How,’’ he said, “ can 
life be tiresome so long as there is still a new rhizopod undescribed ?” 
I once kept him waiting for me nearly two hours on a beach near 
Newport, my horse having gone lame and delayed me. I came up to 
him full of apologies. “My dear Mitchell,” he said, ‘‘just look at 
this worm. lam quite satisfied that it must be new. I turned over 
two stones in this brook, and have found a whole menagerie ; and now, 
I suppose, I really must leave them. lam so sorry.” Have I helped 
you to see what I mean ? No, we cannot all be Leidys, but this 
easily-won delight in nature may be had for the wooing of it by minds 
less great than his. And, too, if your nature-studies make the 
habitual use of the microscope easy, there, too, is a clear gain in 21 
training, for more and more does the doctor’s work involve skill in 
its use. Indeed, it seems to me that all our progress makes more easy 
the possibility of research in remote localities, with small means, away 
from cities. Shall we let ourselves forget that Jenner and Koch were 
country doctors ? To this point of medical education I may return; 
but now I want only to urge that for him who does not care for botany 
or minerals every pond about him offers to his assisted eyes a world of 
tiny vital dramas in the minute life of plant and animal. 
Once I was going to see a patient with a middle-aged physician 
near a Southern city. I asked him how he amused himself. “Oh, 
very well,” he said. “ When I was young I used to read novels if I 
felt tired and had an idle hour; but I found out some years ago that 
the fresh-water sponges were much more entertaining and never by any 
chance stupid. But Ido read novels still; only not so many.” 
I have said that it were well to have a hobby, but that it were 
also well that the side-pursuit you choose should have acceptable 
relations to your own mental structure. I know of many admirable 
physicians to whom all forms of accurate natural history pursuits are 
distasteful or difficult, owing to some defect of intellectual construction. 
We need not pause to analyze ; I for one must admit the fact, because 
I personally illustrate it. My friend Leidy used to smile when I urged 
that I could never be a botanist, because I could by no possibility 
recall the names of species, or even of genera. We once tested his 
own memory after a meeting of the Academy of Natural Sciences, and 22 
found that he was easily master of at least ten thousand botanical 
names, or specific and generic labels. He used to insist that it was all 
a matter of training. I am sure this is not so, and mention it only to 
illustrate my sub-thesis that one’s side-studies—the choice of what we 
make the play of the mind—may have limitations due to individual 
differences. 
There remain, for the use and joy of leisure hours, books. Not 
medical books ; these are for hours of study; and I would like in my 
digressive way to pause a moment on this matter. Once for all I beg 
you to hold me excused for this pleasant freedom, and free to consider 
this the wandering talk of an older man with younger friends. What 
I lose in form and method we may gain in easy pleasantness of state- 
ment. Therefore a word as to medical books. Do not read too 
quickly. Do not let the book devour and digest you. It is so easy to 
float along on the accepted statements of a writer. Print imposes itself 
on the languid reader. There are no bullies like books. Remember 
that what men—even the best—say in books ought to be digested. 
Turn on them the critical tap of your mental gastric juice, to tease and 
solve out their cores of meaning. A little of the bitter cynical bile is 
not out of place. 
Continuous care as to reading gives in the end that swiftness of 
apprehension of things in print which at last results in power to seem 
to skim books and journals and yet to make available conquest of their 
contents. This comes with time, and presupposes large familiar 23 
knowledge and immense previous fractional attention. This is really 
a form of training in the observation of what is set before you in print. 
Become an observer of books, not a mere lazy reader. 
First, then, comes care—attention to what you read. Next 
comes the habit of thinking, as you go, about what you read for 
medical use. The mood of indolent acceptance of what is seen in print 
saves much present trouble. But the neglected opportunities of youth 
are ruthless usurers. Therefore learn to ask yourself if what you read 
is proven; if the observed facts are as stated. A vast amount of safe, 
accumulated knowledge exists in medicine to-day, a vast amount is 
doubtful. The fact which seems certain to-day is to-morrow insecure. 
The sanguine statements as to new drugs and novel methods set forth 
by discoverers or inventors invite and too often justify the caution of 
discreet scepticism. There never was a day when the quiet judgments 
of the general practitioners were more needed. And, after all, it is the 
public opinion of this great jury which decides and keeps a drug in use 
or lets a vaunted method drop into the limbo of rejection. 
Ask yourself as you read if this or that may not be improved 
upon. Longfellow once wrote that it was not well for the man in 
common life to turn somersaults in order to appear original. Appear- 
ance of novelty is not what is to be desired. But when a fresh 
idea occurs to you, put it down in a note-book. Look at it again. 
It may seem valueless to-morrow. There is deceptive self flattery 
about what one’s own brain originates. And yet the habit of 24 
trying to take new views of things, to regard nothing stated as beyond 
some one’s bettering—perhaps yours—is, I assure you, a good plan. 
I have many pages of such notes. Too often these hints for research 
come to nothing; but sometimes they come to a great deal. Above 
all, do not merely stuff yourself with reading. Read thoroughly 
about some one subject at a time, and do not try to keep up always 
with the vast mass of accumulating statements. As to the swiftly 
changing beliefs on bacteria, vital chemistries, and the like, read now 
and then some one of the summarizations of these matters: that will 
be enough. 
And books—other books—what shall I say of these to the young 
man who turns to them as the noble playmates of his leisure? A vast 
mass of good or bad or neutral literature is nowadays cast before the 
world. If you learn early to content yourself with the mere pleasant 
fiction of the day, when more wisely minded you will find it hard work 
to change your diet. It is a law of the mental life that a man grows 
to like what he does long enough; and so, be sure that, if in the youth 
of your career you choose for comrades the master-books of the world, 
you will in time find their wholesome and attractive. Like 
the best of earthly friends, these great books are hard to capture. 
They repay the effort. Like our friends of the flesh, they have their 
limitations; and, as with the friends who are alive, you must not 
expect too much. But the great books are fine mental tonics, and do 
not die. As years go on you turn to them with increasing certainty 25 
of satisfaction, but they must for this have been yours in younger 
hours. 
I think it a sign of narrowness of nature when I find a young man 
indisposed to read the great books. He may succeed in life—it has 
little to do with that—but he will have lost a vast resource and will 
have ignorantly let go by until too late the noblest of friends—the fine 
company of those who, being dead, yet speak. 
lam not so foolish as to tell you not to read fiction. But it is not 
a good exclusive diet, even for the leisure of the young. There are 
times when it is valuable—good as a change. But choose it wisety. 
It is better, I think, for the old or middle-aged. I myself find that 
after a tiring day the best preparation for sleep is a pleasant hour over 
some absorbing novel. But as to this men’s tastes vary. Nor less as 
to that noblest branch of literature-—verse—with which our profession 
has some interesting relation. In fact, it has produced many poets, 
and men as grave as the great Haller have written good verse. For 
many active men in our profession I have known poetry to be in their 
busy lives what music is to some people. But as with music, so with 
poetry, the taste must be natural, or at least cultivated in youth. 
Reflect, then, what it is I urge upon you. Poetry means the most 
elevated thoughts iu the most condensed form of the best language, 
told to the music of rhyme and rhythm. 
The best literature of prose and verse is what I ask you to make a 
part of your mental outfit for that profession in which no accomplish- 26 
ment can possibly be wasted. You deal not with the bodies of men 
alone; woe to them and to you if this be your definition of medicine. 
Men’s souls, men’s lives, their thoughts, passions, and temptations, 
their secrets and crimes, come all within the range of your experience. 
In the serene atmosphere where soar and sing the great masters of 
human passion you may learn to live with an ever-broadening and 
ever-kindlier view of life, and acquire that charity toward the weak- 
nesses of your fellows which for the better nature is the sure outgrowth 
of large knowledge of men, however learned. 
This is not a lecture on literature; and were it that, it should be 
needless to point out what are the great books in prose or verse with 
which a thoughtful man ought to desire to be intimate. They are the 
books which have generated libraries of comment and criticism. They 
are the books which contain the flower, the fruit, and, too, the seed, of 
thought. Tike those vast forms of stone, or god or king that sit 
among the desert sands of Egypt, they fill us with wonder, and tax 
alike the imagination and the intellect. 
Learn, then, to know well some of these records of human genius 
at its summit of productive power. This is the best society a man can 
keep. Here are the best talk and here the noblest manners. Do not 
think of me as exceeding in my enthusiasm the limits of reasonable 
advice. In sickness, in trouble, in hours of vexation and days of dis- 
appointment, the greatest of our kind have found compensation and 
consolation in the company I recommend you to cultivate. I remem- ber that one evening the late James Russell Rowell walked to and fro 
in my library. Now and then, pausing, he picked a volume from the 
shelves, glanced at its contents, and said pleasant, wise, or merry 
things of it or its author. It was as though he were answering some 
skillful talkers. It was like gay chat of which I heard but half. At 
last he said : “I wonder if young men comprehend what they miss 
in not learning to love the best books. Many times in my life,” he 
added, “ I have turned to them for help and distraction when every- 
thing else on earth seemed to be as dust and ashes. While a man has 
books he need never think of a monastic life as a refuge from moral 
disaster.” 
Rord Macaulay has left us an interesting poem in which he, too, 
records at a time of bitter disappointment what literature was to him, 
and what it has ever been to those w7ho seriously apprehend its values 
and its possibilities of moral helpfulness. In imagination the fairies 
who endow the cradled child with gifts of fame and power and wealth 
pass him by, but one stays to give of her best. She who represents 
the love of letters leaves with him this gift, and says : 
“ Yes, darling, let them go ; so ran the strain : 
Yes, let them go—gain, fashion, pleasure, power, 
And all the busy elves to whose domain 
Belongs the nether sphere, the fleeting hour. 28 
“ Without an envious sigh, one anxious scheme, 
The nether sphere, the fleeting hour, resign. 
Mine is the world of thought, the world of dream, 
Mine all the past, and all the future mine. 
“ Fortune, that lays in sport the mighty low, 
Age, that to penance turns the joy of youth, 
Shall leave untouched the gifts which I bestow, 
The sense of beauty and the thirst of truth. 
“ In the dark hour of shame I deigned to stand 
Before the frowning peers at Bacon’s side; 
On a far shore I smoothed with tender hand, 
Through months of pain, the sleepless bed of Hyde : 
“ I brought the brave and wise of ancient days 
To cheer the cell where Raleigh pined alone; 
I lighted Milton’s darkness with the blaze 
Of the bright ranks that guard the eternal throne. 
“ Ah, when on restless night dawns cheerless morrow, 
When weary soul and wasting body pine, 
Thine am I still, in danger, sickness, sorrow, 
In conflict, obloquy, want, exile, thine.” 
This is a very real thing of which men like Towell or Macaulay 
can so speak or sing. You do not need it to make dollar-winning 
more easy; many men great in our profession forever miss it; but, 
believe me, it is a thing to win with effort, and worth the winning. 29 
There are men who do not—never will—care for it, and there are some 
who care neither for nature, nor art, nor gun, nor rod, nor saddle. I 
can but feel a sort of mild pity for such people. Believe me, the more 
things you can put into life without doing harm to its definite duties 
the happier will it be. 
It must often happen that whether you study natural objects or 
find in literature occupative change, some of you may be tempted to 
put in print your observations or your thoughts. Also, it is possible 
that among you may be one or two who have the power to better 
in verse than in prose what they feel and think. Observe my words, 
“to say better in verse.” If the thing cannot be said better in verse 
than in prose, then, by all the Muses, hold your tongue so far as verse 
is concerned; and in any case be certain that what you want to say is 
worth saying at all. But, whether you write prose or verse, do not let 
the pleasure of recording thought fill you at once with ambition to see 
yourself in print. The use of the pen is for many minds needed to 
give definition to thought. For me this has always been the case, and 
whether it be a mere literary statement or a problem in toxicology or 
medicine, it only grows clear to me on the written page, and perhaps 
only then after repeated efforts to put it in words. But be careful how, 
as medical men, you print anything. If you write something not 
medical, and think you have done a good thing, look at it in a year or 
two. The partiality of the mother for her first-born is but mere 
neutrality of preference compared to the young writer’s affection for 30 
what he calls the offspring of his brain. Too often there may be grave 
doubt as to the legitimacy of these children. At all events, beware of 
the fatal audience of one ; the !’s always have it, and unanimity settles 
the question. Pray note that I think it a good thing to use the pen; 
but be wary of inflicting its product on others. 
There is yet another and a graver reason why you should in 
your young lives consider literary product as but mental gymnastics. 
Rightly or not, the public, especially in small towns and the country, 
believes that a doctor should be that and nothing else. The feeling— 
the prejudice I prefer to call it—is fading away in great cities, where 
generally a man may do as he will if only he makes it sure and obvious 
to all men that the distribution of his energies does not affect his value 
as a physician. It were best to err on the side of caution, and to wait 
for larger personal freedom, until in early middle life you are certain 
of that professional success which, after all, is and ought to be the 
main object of your care. You will pardon me if I speak so often of 
myself, but the story, now well known, is worth the telling over. 
When I was yet young, being of opinion that I had written some good 
verse, I sent it to a Boston publisher, who agreed to print it. Then 
came a letter from Oliver Wendell Holmes in which he said that he 
had been asked by the publishers to read my little book. He wrote 
•that, after some hesitation, he had resolved to give me a piece of 
unasked advice. He said that, having read my verse and being 
familiar with such medical papers as I had written, he thought he ought to say to me that I could not hope to succeed both in medicine 
and literature. He counseled me to withdraw the poems, to put them 
in a drawer, and to look at them again when I was forty years old. 
Not without a pang I took his advice. 
With this too personal’ illustration, which I would readily have 
replaced by another had it been in my power, I draw to a close. I 
wished to show you how to make use of the variety of mental qualifica- 
tions which one and another of you may possess. I wanted to point 
out how in their use you may avoid the evils which their exercise may 
bring to your careers. 
I might have added a few words as to the morals of young phy- 
sicians—as to the temptations which beset the hours of idleness—the 
coarser temptations, I mean—but no sermon can be complete. I prefer 
to leave to the preacher we all carry within us such obvious lessons as to 
these matters of moral conduct. I shall be well enough repaid for the 
easy labor of advice if, in days to come, in hours of trial and vexation, 
you return at times in thought to what I have now said, and find in its 
remembrance any help toward the successful conduct of righteous and 
wise living. In my next lecture I can promise to be more practical, 
because I shall deal chiefly with every-day questions of a professional 
nature. 11. 
I have long looked forward with pleasant anticipations to these 
talks with students. The realit)" has blocked my way with difficulties. 
There is so much to say. I soon saw that I must choose with care 
what to discuss, and risk the want of appearance of continuity. If all 
of you were to be town or country doctors my task were more easy; 
but some the navy will claim, or the army, and others will drop into 
special lines of work. 
I shall try to remember only that you are all to be of the great 
army of medicine. First of all I own for the wish that in this 
vast organized body you shall take honest pride. Through it you will 
earn your bread, and, I trust, much beside a mere living. That you 
may correctly estimate its splendid history, that you may fitly com- 
prehend the opportunities it gives, let us look a little broadly for a 
time at some of its virtues and some of its values. I could wish that 
you were really taught something of the wonderful of medicine.1 
I have, myself, ancestral pride in the splendor of its conquests, the 
courage and heroism of its myriad dead. lam fond of saying it is a 
guild, a fellowship, a brotherhood, older than civilization. It had a 
creed of moral life antique when Christ was born. No other organiza- 
tion is like it. Customs, code and creed separate the lawyer and 
1 This is now provided for in the four-year course of the University of Pennsylvania. 33 
clergyman of different lands, but we in all lands hold the same views, 
abide by the same moral law, have like ideas of duty and conduct. 
From Japan to London you may claim medical aid for self or wife or 
child, and find none willing to take a fee. There is something fine and 
gracious in this idea. 
I once asked the care of a physician I never saw or heard of before 
in a German town. As I was about to pay him a card dropped from 
my pocket-book. He glanced at it, said, “But you are a doctor; I can 
take nothing—nothing.” I remonstrated in vain. “No,” he said, “you 
will make it up to some other doctor.” I believe that I have paid this 
debt and other like debts with interest. I hear now and then of men 
who break this beautiful rule which makes professional service given 
by one physician to another a friendly debt for which the whole 
brotherhood holds itself responsible. Doctors are said to differ, but 
these bonds of union and generous amity are mysteriously strong. 
Try to keep them so, and when you serve medical men go about it as 
if they were laymen. Put away all thought of wasted time, of the 
commercial values of what you give. The little biscuit you cast 
on the waters will come back a cheerful loaf. I consider it a glad 
privilege to help thus my brothers in medicine, and let me assure you 
few are more heavily taxed than I. 
And there is another privilege your profession brings. From the 
time you graduate until you cease to work, whether in town or country, 
hospital or wretched homes, the poor will claim from you help in their 34 
time of sickness. They will do it, too, with tranquil certainty of 
gracious service on your part. 
The greatest of moralists has said, “The poor ye have always 
with you.” I think he meant to speak of the poor as representing 
opportunities for self-sacrifice never absent. Of a certainty it applies 
to us. The poor we have always with us—the sick poor. The 
unthoughtful public believe that our easy readiness to give of our 
skill and time to the sick comes largely out of our consciousness that the 
experience won in this service is valuable. This is true, but not the 
whole truth. Experience is needed in the training for every form of 
work, but neither in law nor trade does a man expect to acquire capacity 
by calmly giving away time and skill after he has completed his 
primary education. 
Imagine a law hospital where the highest talent is to be had 
without money by any man too poor to carry on a righteous law-suit. 
There are none of us who do not do and have not done more in 
the unpaid care of the sick than was needful for our mental training. 
Whether we like it or not this service is essential to the young, and 
valuable at all ages. However harassing, however unjust in its excess, 
however absurd, try always to get out of it for yourselves and others 
all that you can. The virtues men affect become their own. An 
inexorable and noble part of our unwritten creed makes such charity 
so completely a portion of our lives that at last, even for the most 
selfish, it comes to have the unquestioned force of a mere bodily habit, 35 
and this is as it should be. The virtues which grow to be thought- 
lessly habitual are none the less virtues. We tell the truth, are 
honest, are just, or punctual, because the qualities in question have 
grown to be a part of us. At last they exact no effort, involve no 
indecision, and above all no self-praise. And so it is that with us the 
gift of our mental and moral best to the poor becomes an unquestioned 
necessity of our nature. These onerous claims lessen as life runs on. 
None altogether escape this form of charitable expenditure. But 
each virtue has its attendant evil. An eastern proverb says, “every 
angel has a twin devil.’’ This constant unrequited service of the sick 
poor has its danger to character. I have felt it myself. I want you 
to feel it. 
On every Friday I conduct the clinical out-service at the Infirmary 
for Nervous Disease. I never go through these long and tiresome 
hours of intense attention without feeling that it is needful to put 
some stress on myself that I be not negligent or hasty, vexed, or 
impatient, or fail as to some of the yet finer qualities of social con- 
duct. I want you also to feel that such self-watchfulness is needed. 
These early years among the poor, or the class of uncertain debtors, 
are apt to make some men rude and uncareful, and ill-tempered. Most 
honestly do I say that such work is what I may call an acute test of 
character. 
In this service a mass of little undermining, mean temptations 
assail you. When I have watched a young resident a year in my 36 
clinic, I know whether he will succeed or not. If he fail in the 
hospital, he will fail in life. It is a sharp test, I admit. Here are the 
sick poor, at times ill-mannered, surly, ungracious, ill-tempered, 
harassed by cares you know not of. There, too, are nurses ; and 
there is the visiting M.D., with his exactions, and expecting you 
to know everything. In your early practice at home, away from 
wholesome criticism, you will go your way for good or ill, and become 
your own critic. Are you careful then or uncareful, conscientious or 
not, gentle, charitable, thoughtful or not, no one reproaches you with 
failure. Some sad day, in middle-life, you feel that your fellows have 
gone by you. You ask yourself, why? Alas ! by that time you will 
have lost competence for self-criticism, and will conclude upon luck 
as your foe. An old friend of mine used to say some men always spell 
Buck with a P before it, and some without it. Observe, now, that lam 
but casting out hints, that I am pleading for the careful, early con- 
struction of habits now, here, at the immature age. That was a wise 
man who said: 
“ Sow an act and you reap a habit, 
Sow a habit and you reap a character, 
Sow a character and you reap a destiny.” 
Before leaving this question of unpaid work, of which we do so 
much and learn to think so little, a word more as to one aspect of it. 
I am doubtful whether any constantly unpaid work is always the 
best work. Note my phrase, constantly unpaid work. Experience 37 
won is our pay, says a public well content to be eased of the burden. 
But this applies also to the unpaid nursing sisterhoods, of whose devo- 
tion we hear so much. A queer, moral trap is set for some natures in 
all this; one ’may easily over-esteem what is one’s pure gift. It is 
deeply human to conceive of devotion to pecuniarily unrewarded work 
as in all respects an insurance of competency. But sisterhoods do 
not give us better nurses than we get outside among the paid and 
trained. A vow does not exclude defects, moral or mental, nor 
convent or hospital shut out motives of this world. Nor, on the other 
side, does the fact that work is paid for deprive us of spiritual motives 
or the finer incitements to perfectness of method and manner. 
The nobler the nature the more surely does the fact of wages add 
to the obligations of dutiful action. That you get a dollar for doing 
this or that surely does not exclude even the highest religious motives, 
and it adds a wholesome, earthy motive which may be base enough if 
you choose to put it before all others. 
And, now, after this seeming digression, let us clear our way a little 
for its applicative uses. A part of your life-work consists in giving of 
your best to those who cannot pay. A part consists in work for honest 
wages. I think you happy in that our work is not altogether paid 
labor, and not wholly work without pay. In both are chances which, 
rightly used, make the good better, the wise wiser; and there are many 
sides to it all. 
In a country like ours you will find, and not rarely, that by-and- 38 
by these poor who so cling to you are no longer, poor, and that among 
them are some who rise with you in life. The other day a wealthy 
manufacturer who came to me with his grandson reminded me pleas- 
antly that in our young lives I had given his family unpaid care for 
years, and then he added, “but I have tried to get even,” and that 
was true enough. 
I do not like to leave this subject without a living illustration. 
It is strange and interesting to see what our life does with different 
kinds of men. 
I once went through a hospital ward in France watching the work 
of a great clinical teacher, long gray in the service of the sick. It was 
as pretty and gracious a thing as one could see. The examinations 
were swift, the questions few and ready. Clearly he liked his work. 
A kindly word fell now and then ; faces lit up as he came near. Now 
and then he answered a patient gravely and simply where there was 
real reason to do so, and twice I observed that when he did this he sat 
down as if in no haste—a nice trait of gentle manners. It was a ward 
of women and he was very modest—a too rare thing in French hos- 
pitals in my student days. When he went away his interne told me 
that he had been very sharp with him for a piece of neglect, “ but,” 
said the young doctor, “ he never says a word of blame at the bedside.” 
In fact, this great physician was a gentleman—much-abused word—but 
think what that may fully mean : a man in the highest sense of man- 
hood—so gentle, good old English word, that every little or large act 39 
of duty or social conduct is made gracious and beautiful because of the 
way of doing it. 
I saw a week later a great French surgeon in his clinic for women. 
The man was as swift, as skillful as could be. He was also ill-tem- 
pered, profane, abrupt and brutally immodest—a strong, rough, coarse 
machine ; and this was what the medical life had done with two men. 
With less intellect this rude nature must have altogether failed of 
success in life. He did not fail, being a man of overwhelming force 
and really admirable mental organization ; and so when you read of 
Abernethy’s roughness and the like, pray understand that such great 
men as he win despite bad manners, and not because of them. There 
is no place where good breeding and social tact—in a word, habitual 
good manners—are so much in place as at the bedside or in the ward. 
When Sir Henry Sidney wrote a letter of advice to his son—the greater 
Sidney, Sir Philip—he said, “ Have good manners for men of all ranks ; 
there is no coin which buyeth so much at small cost.” The too com- 
mon trouble as to this matter is that men who lack really good man- 
ners seem to be wanting in knowledge of their own defect. The finer 
nature has the more delicate social conscience, and is swift to feel its 
own wants or mistakes. You are now at the age when the school of 
social conduct closes. No one says “ don’t Bill,” or “Tom ;” no one 
now says you were right as to this or that, but the manner of the doing 
was ill and hurt your purposed efficiency. Be, therefore, in your 
young lives most watchful, yes, and most thoughtful, as to this matter. 40 
A clever woman of the world once said to me: “I sent for Dr. A. 
yesterday, and by mistake the servant left the message with Dr. B. 
He came at once, and really he was so well-mannered and pleasant 
that I quite forgot what a fool he is.” 
I know men who have had large success in practice chiefly 
because of their gentleness and sweetness in all the relations of life. 
I know of far more able men who have found life hard and the winning 
of practice difficult simply because they lacked good manners or 
wanted tact. We began about the poor, and here we are discussing 
manners. I had not meant to say of it so much, but on the whole I 
am not sorry. Pray remember, finally, that neatness of dress and the 
extreme of personal cleanliness are, shall I say, a sort of physical good 
manners, and now-a-days the last words of science are enforcing these 
as essentials of surgical success. 
Det us turn aside from these questions. I presume you to be 
placed with hope of practice in town or country, and here again I am 
puzzled how to choose the points on which I want to advise you. Let 
us look at the health question first. There is no success for you with- 
out health. The energy of full vigor makes itself felt in our work as 
in no other pursuit. I have often felt that. Sometimes the energy 
has gone out of me. The English say to become a Lord Chancellor a 
man must have the three B’s—Back, Belly and Brains. Vigor, good 
digestion, intellect. Into your lives will come loss of sleep, irregular 
hours, delayed meals and daily worries. As to these latter they are as sand in the machinery of life. “ I,earn to laugh, and you are your own 
doctor,” say the Turks. A natural sense of the humorous is an 
unusual help. I hope you have it. But if you cannot acquire that 
gift of the fairy nature you can at least learn cheerfulness, and by 
habit to cease to think of your bad cases more than their problems 
demand. 
Our open-air life is a great safeguard. We suffer little from 
neurasthenic conditions, despite the seemingly unhealthful conditions 
which surround us. 
But try to get, while young, some daily active, violent use of your 
muscles. For the county doctor the back of the horse is available, 
and as Ford Palmerston said, the outside of a horse is good for the 
inside of a man. Try soon to get every year a little divorce from all 
3rour physical and social surroundings. I have a prejudice in favor of 
the rod or gun. But whether in canoe or afoot be sure that a little 
wood life, away from all you know, is what the Indian calls ‘' great 
medicine ’ ’ for mind and body. There is a strange moral influence in 
the life. You come back better, wiser, innocently sweetened all over, 
and by lake or river you forget and forgive with natural ease. I think 
that doctors are apt to be a little reckless as to their own risks of 
disease. They have seemed to me to share the popular belief that in 
some mysterious way we are guarded from contagion. Nothing could 
be more foolish. Never be ashamed to take reasonable precautions. 
I have myself twice taken diphtheria from patients, and once 42 
small pox. I think my own maladies taught me some good lessons, 
and few of you will, I fear, quite escape such opportunities of knowing 
disease from the standpoint of the patient. The records of typhus 
and yellow fever epidemics tell a sad tale of such disaster in our ranks, 
and I may add that in the great civil war surgeons suffered death and 
wounds in equal proportion to line officers of the like ranks. 
Be reasonable, therefore, in your care of yourselves. There comes 
a time now and then when we want the most sturdy health—for the 
battle with epidemics, or for the honest wrestle to save some single life. 
Then, as in war, all questions of convenience, safety, ease must disap- 
pear before the unquestioned call of duty. 
Among country patients and doctors a certain amount of friendly 
relation and more or less familiarity is apt to grow up. In cities this 
is less certainly the case. “As a rule,” said a wise physician to me, 
a young man, “you will do well to let your patients be friendly, but 
be yourself careful how you make friends of them.” Whim, caprice, 
accident, absence, cause them to leave you for another practitioner. 
You will not like it, no man does, but, if you are personally attached 
to them the pang will be sharper. Any large practice in a great city 
is continually changing. Patients leave you, others come. Another 
man who complains to you of his patient leaving him for Dr. A. or 8., 
will always seem to you a little childish. Take care. There is noth- 
ing in life more valuable than a true sense of the ridiculous applied to 
ourselves. When a patient leaves you, try to see why you failed to 43 
hold the case or family. If it was not through negligence or want of 
earnest care, do not let it annoy you or disturb your relations to them, 
or the more lucky doctor. But be honest in your self-examination, and 
remember my old doctor’s advice—don’t try to make friends of 
patients, and do not get to think you own the sick man. I scarcely 
ever go for consultation to a village that I do not find some little 
bickering among the doctors. Most of it comes out of loose talk and 
critical comments, or from loss of cases who go here and there and 
leave you. Bet me beg of you finally, now in advance of these inci- 
dents, and they come to all, to resolutely accept them as a part of the 
changeful fates of life. Try to look down on life as a whole. How its 
smaller calamities affect your character is of far more moment than 
how these for a passing hour influence your material fortunes. Guard 
too your own tongue. I saw over an inn in the Tyrol in the queer 
old Romansch dialect these words, “ Critica ast facile.” To find fault 
is easy. Yes, it is very easy, and it is something else. 
There is a wise proverb of the East, “ He who holds his tongue 
for a minute is wise with the wisdom of all time.” I am fond of 
proverbs, and this is full of meaning, for really to refrain from instant 
speech when irritated is victory. An hour later you are sure to be 
silent enough. The temptation to speech is momentary. Above all, 
try not to talk of your patients—even with doctors. It is usually a 
bore to be told of cases, and we only stand it because we expect our 
own boring to be in turn endured. But my ideal doctor wTho reads, 44 
thinks, and has a hobby will not need to gossip about patients. He 
will have, I trust, nobler subjects of conversation. When I hear a 
young man talk cases or read them in societies with heavy detail of 
unimportant symptoms I feel like saying of him, as was once said in 
my presence of one who amply justified the prediction, “ That man has 
a remarkably fine foundation for dulness in after life.” 
The life and ways of a country physician make it rather hard for 
him, as his days fill up, to do all the reading he should do, but if in 
town or country you were to be let into the whole life of a man you 
would always find more unused hours than the lazy care to admit as 
existing. I have all my life wondered how doctors, even the busy, fill 
up all their time. 
For the country doctor there is most excuse. He has to know so 
much. He has to rely so completely on himself. As a result, the best 
country physicians are better all-round practitioners than the up-and- 
down town men of cities, who can in an hour of doubt find counselors 
close at hand. 
In any case, no matter what may come to excuse later deficiencies, 
begin and try to continue a system of notes of cases. Their value 
comes to be immense—their value to you I mean. Index them as to 
names and diseases. At the close of a case read it over and make com- 
ments. As regards the odd and curious, keep a special index. As 
time goes on the accumulated knowledge as to individuals and families 
gathers value. I saw a few years ago a case which had puzzled a 45 
friend. I turned to my notes of twenty years ago and found in the 
dead father’s case a story of syphilis, which brought clear light into a 
difficult consultation. If the whole medical story of successive genera- 
tions could be kept, how strangely interesting it would be. I have 
myself several thousand records of my cases, and every now and then 
some one turns up whose history of years ago is in my books. 
The methods of note-taking you are well taught, and, too, I hope, 
the best ways of examining your cases. As to this, circumstances 
must guide you. A patient is often a bad witness, and one man gets 
at the truth of his case, another does not. 
As to acute cases, it is immensely valuable to learn through con- 
centration of attention to be rapid without omissions. Dr. Edward 
Dalton is quoted assaying to his class, “Aftercareful and repeated 
auscultation, percussion, palpation and even succussion of your patient 
for twenty minutes, you may not be verjr tired. He is.” 
As you go on in practice you will get to be fond of certain drugs. 
Be a little careful of this habit, which has its reasonable side. Even 
the best of us fall into this therapeutic trap. I once met in consulta- 
tion the late Prof. Blank, a delightful and most able physician. As I 
came out of the house I fell upon his son, also a doctor. “Ah !” he 
said, “ you have been meeting my father; lam sure he advised Plu- 
mer’s pills”—an old mercurial preparation. It was true. 
As I watch the better medical practice, I see a tendency to rely less 
upon mere drugs, and more and more sharply to question their value. 46 
The true middle course is to be skeptical as to new drugs, and to test 
them over and over before being mentally satisfied. Nor is it well to 
run into the extreme which in our civil war caused an order forbidding 
the use of calomel because of the folly and indiscretion with -which a 
few men had used it. After all, one of the most difficult things in ours, 
the most inexact of sciences, is to be sure of the value of a drug. 
When studying the poison of serpents I found the most positive printed 
evidence of the certain value of at least forty antidotes. Not one of 
them was worth the slightest consideration. Such a fact as this makes 
one careful of crediting the endless cures to be read in the journals. 
When you come to read over the works of the great masters, dead 
or living, and to see how Sydenham or Rush, Cardan or Bright, did 
their work, you will be struck, as I have been, with the great stress 
laid upon habits of living, what shall be eaten, diets, exercise, clothing, 
hours of work and rest. Curiously enough, these dicta are more often 
found in their records of cases than as positive theses ; a proof that, in 
his practical work, a man may be better and wiser than in his generali- 
zations. When, therefore, you come to deal with chronic conditions, 
be sure to learn all there is to learn as to the ways of men, their diet, 
clothing, sleep, work, play, wine and tobacco. I like to make a man 
describe to me, with minute care, his average day. Then I consider, 
usually, how much of what is clearly wrong may be set right by a life 
on schedule. After that comes the considerate use of drugs. 
The desire for drugs is a remainder from barbarous times. It is 47 
much in the way of what I call natural medicine. Do this and do not 
do that, might cover a large amount of useful treatment if men would 
but consider the doctor as a wise despot to be implicitly obeyed. But 
just here I wish to add that the very men who are most chary as to 
drugs are those who, at times, win splendid therapeutic victories by 
exclusive diets, or heroic use of powerful medicines. 
Much nonsense is talked about the injurious influence of drugs 
until, in the very word drug, there is a malignant sound. Men used 
to be over-bled or salivated. This does not occur now-a-days. And 
if I asked your whole faculty how many people they have seen perma- 
nently injured by mere medication, I fancy they might be puzzled to 
bring to mind illustrations of such mischief. The belief is another 
survival of conclusion founded on premises which perished long ago. 
I pause for another word of caution. Let me entreat you to be 
careful as to narcotics. Never leave to a patient the freedom to use 
them at will. They are too often the easy resort of the lazy doctor. 
Pain is a sad thing, but be sure that the frequent use of opiates myste- 
riously increases the future capacity to feel pain. Nearly always the 
attendant physician is in some way to blame for the opium habit. 
Above all, be careful in your own households. Few winters pass with- 
out bringing to me three or four morphia cases in doctors’ wives. Cer- 
tainly it is a sore thing to see the pain of those we love ; the tempta- 
tion to give instant relief is great; affection is a poor consultant. You 
yield, and at last a habit is made, and the more easily because the drug 48 
is too readily at hand in the homes of country doctors. The moral is, 
do not attend the sick in your own household. There are many rea- 
sons why it is unwise. Save as to these matters doctors are the best 
husbands in the world. 
Men in our profession fail more often owing to want of care in 
investigating cases than for lack of mental power. There are exact 
sciences and inexact sciences. If ours be a science at all, it lies among 
the inexact. Try, then, always to be as exact as possible. Let me 
show you what I mean. Let us take for illustration the urine, and 
suppose the case a difficult one. Is the patient gouty or lithaemic? 
One man looks at the urine carefully once and decides; another looks 
once at the night and morning water and concludes; a third asks that 
there be made no change in diet or habits for a week, and examines 
the urine over and over, both the night and morning secretion. Of 
course, this is the only right way. Troublesome? Yes, very! If 
you do not want to practice medicine as it ought to be practiced, better 
far to get some business which will permit of indolent intellectuation. 
A friend of mine had a consultation in the country as to a case of 
great importance. The attendant fell ill and could not meet him. My 
friend went over the case with care. It was one of persistent head- 
ache. He took home urine of the night and morning, and wrote word 
that the patient had uraemic toxication. The attendant said “ No; that 
neither casts nor albumen were in the urine which he had thrice 49 
examined.” At last, puzzled, my friend asked if lie had studied the 
night urine. He said “no.” And here was the mischief. 
I saw to-day a woman of wealth and social importance, who for 
years suffered cruelly from headache. Now, as it always began after 
an hour of very acid vomiting, a dozen of the ablest men in Europe and 
America, who were led off by the vomiting, failed to take in the whole 
possibilities, and did not question the eyes. But a little country doctor 
did, and a tendon or two clipped put that woman back into a state of 
health. I was one of those who made the mistake, and yet I have 
written, was perhaps the first to write on the eye as a cause of headaches 
of varied type. But to be constantly complete and exact in all exami- 
nations is, I admit, hard ; nevertheless, that way lies success. 
And the like axiom applies to treatment. You are taught in 
acute disease to write your directions and to leave no possibility of 
change unprovided for. And the acutely ill are prisoners of our will. 
But how many men think it needful to write out a schedule of life, 
medicine, diet, exercise, rest for cases of chronic disorder, I do not say 
disease. I never tire of urging that in attention to minutiae lies the 
most certain success. A large practice is self-destructive. I mean 
that no over-busy man can continue to give always, unfailingly, the' 
kind of care patients ought to have. But that is as I said in my first 
lecture, a question of enduring energy, and of the firmly made habit of 
dissatisfaction with the incomplete. If medicine consisted only in 
mere intellectual endeavor; if t© see, hear, feel, weigh, measure, in a 50 
word, know all there is to know of a case, were really all; if then we 
only had to say do this or that, one’s life might be sufficiently easy. 
In time of peril, or under stress of pain, any one, and always the 
great consultant, can secure absolute obedience. In the daily current 
of practice, fancy and unbelief, indolence, prejudice and what not, 
stand in our way. Busy men, indulged children, hysterical women are 
your worst difficulties. Then come into play the moral qualities which, 
in union with educated intellect, make for the triumphs of the great 
healers of their kind. Are you gentle, and yet firm ? Have you 
the power of statement; which is so priceless a gift, the capacity to 
make the weak, the silly, the obstinate feel as you speak that your 
earnestness rests on foundations of kindness, and of thoughtful inves- 
tigation of their needs ? Can in a word, make people do what 
you want ? Save you the patience to wait, untroubled by the follies 
of the sick, to bide the hour when you can carry your point? Have 
you the art to convince the mother that the sick child is the last of all 
who should be left to the misery of self-indulgence ? Can you sit by 
the bedside and gently satisfy some hysterical fool of her capacity to 
take up anew the reins of self-government ? It demands earnestness. 
It means honest beliefs. It exacts such rule over your own temper, 
such good manners as few possess in their highest degrees of quality 
and quantity. Above all, it means that dislike of defeat which makes 
the great soldier. 
A fine thing in our profession that mere hatred of defeat. As I 
came once out of a consultation with Prof. Gross, he said : “ Don’t you hate it, sir?” “Hate it; what?’’ I said, “hate what?” “Oh, to 
spend a life like yours or mine, and be beaten—puzzled—licked, sir— 
by a miserable lump in a woman’s breast.” I always liked what Gen- 
eral Sheridan said to me years ago. I asked how he accounted for his 
constant success in war. He hesitated and then replied: “It was 
because I did so hate to be licked,” No matter whence comes this 
feeling, it is valuable. Cherish it; never lose it. Find reason for dis- 
aster, but learn to loathe the result. I never see a death or a grave 
failure to cure that lam not personally hurt by it, I say then, ‘‘ a 
century hence this will be otherwise,” for, as I am proud of the past of 
this great guild, so am I full of glad hope for its future, when it shall 
have learned the conquest of cancer and tubercle. 
I have come again half unexpectedly, as I draw to a close, upon 
this grave question of the moral qualities needed for the noblest success 
in medicine. It would lead me, and easily, to talk of the code, of your 
relations to the secrets of households, to the criminal law as to wit- 
nesses, of insurance cases and the like, but all of this I must leave 
unsaid and reject the pages in which I had said something of the ethics 
of our profession. 
You have chosen a life inexorably hard in what it asks of soul and 
mind and body, but be that as it may, you have taken upon you, I 
surely think, the most entirely satisfactory of earthly pursuits. I have 
seen much of men and their ways, but nothing I have seen entitles me 
to think there is any truer, better way of serving God and man, and in 
this service making yourselves what you ought to be.