AN INTRODUCTORY LECTURE, TO THE COURSE OF SURGERY, DELIVERED TO THE STUDENTS OF WASHINGTON MEDICAL COLLEGE OF BALTIMI)|I|E BY JOHN R. W. DUNBAR, M.D. FORMERLY PHYSICIAN TO SOUTH. DISP. OF PHIL. AND SEC’RY OF PHIL. MED. SOCIETY, HON. MEMBER OP MEDICAL SOCIETIES OP PHILADELPHIA AND BALTIMORE. AND MEMBER OF THE MARYLAND ACAD. OF SCIENCE AND LITERATURE. PRINTED BY JOHN D. TOY. BALTIMORE: 1837. Washington Medical College, November 11, 1837. Sir ; At a meeting of the students of Washington Medical College, held yesterday afternoon, Mr. Ahijah G. Smith, being called to the chair, and Mr. Septimus Dorsey, appointed secretary, it was unanimously Resolved, That a copy of your excellent and appropriate Introductory Address delivered to them, be respectfully requested for publication. We, a committee appointed for that purpose, in the fulfilment of our duty take great pleasure in presenting you this request, to which we add our personal solicitations. We remain, sir, yours, with all due respect, J. Sermon Worrall, G. Washington Crawford, H. D. MacCulloch, Richard Hammond, Christopher C. Cox, S. E. Treadwell, Committee. To Professor Dunbar. Baltimore, November 12, 1887. Gentlemen: Your letter informing me that a resolution had been unanimously adopted, by the students of Washington Medical College, requesting a copy of the Introductory to the course of Surgery, and appointing you a committee for that purpose was duly received. To a request so complimentary and gratifying, I do not feel at liberty to give a refusal. But permit me to say, that as the Lecture was written for a popular audience, and in a style better fitted for the excitement of a lecture hall, than for calm perusal, I fear that those who may read it will not deem it worthy of the honour you have conferred, in requesting its publication. Were I influenced alone by considerations of my own reputation as a writer, I ought perhaps, to withhold its publication, but as it was written and deli- vered with a heart deeply interested in the welfare of the student of medicine, I consent to it with the hope that it may be the means of raising a warn- ing voice, and arousing him to a sense of the importance of the duty which devolves upon him in his probationary career—and that it may awaken the energies of some noble spirit to devote himself unceasingly to the advance- ment of a profession, certainly one of the most useful and valuable to the happiness of the human race. With a sincere hope that you individually, and those you represent, may become bright and shining lights in the firmament of medicine, and with best wishes for your health and happiness. With sincere regard, your friend, To J. Sermon Worrall, J. R. W. Dunbar. G. W. Crawford, H. D. MacCulloch, R. Hammond, Christopher C. Cox, S. E. Treadwell. INTRODUCTORY LECTURE. Gentlemen: The science of medicine comprehends various branches: my colleagues have introduced their ap- propriate departments, it will be my care to ask your attention to that of surgery, the duty of teaching which is assigned me in this college. It is very far from my intention to take up any of the abstruse points of this subject, for this would be out of place in a mixed audience, but briefly to glance at the necessity which produced this art, its progressive improvement, and value in relieving the sufferings of mankind. Throughout every period of man’s history he has been exposed to accidents, wounds and injuries, either from the beasts of prey, or from his fellow men, more remorseless than the fiercest of the beasts of the earth. Hence, the necessity of close attention to the means of remedying these injuries. They soon became aware of the danger from the flow of blood, and this regulated all their efforts at improve- ment. Through many ages of the infancy of the 6 human mind they groped their way lighted by the dim torch of experience; the same process was gone through as in all other departments of human know- ledge. They watched through the long night of ignorance until at length a streak of light began to tinge the horizon, but in fact rendering the darkness more visible and showing a dim outline of the bogs and difficult passes in which they had toiled through the night; by and by the light increases, expands and illumines the whole horizon, tinging the clouds with the rosy light of morning; then the beams of the god of day gilds them with his golden hues and he bursts upon the world with his full-orbed glory, casting his rays of light over the earth. So in this science knowledge has been continually advancing. With the progressive knowledge of the structure of the body it has gone hand in hand. The ancient surgeons had acquired great perfection in the instru- ments which they used to perform operations, most naturally, for the inventive faculties are those most called on, and earliest brought into action in our nature. So these surgeons were most ingenious in making instruments to assist the hand in their opera- tions ; so much so, that they have left but little for their successors. In proof of which, no sooner does some ingenious surgeon, burning with the desire of fame promulgate some new instrument, than there most provokingly comes forth some old antiquarian, deeply read in the old fathers of medicine, who proves from the dusty page, that it was used, perhaps thrown by 7 ages before as valueless. But the great barrier in the progress of the old surgeons was the fear of blood; it has been truly observed, that if there was no bleeding, there would be many surgeons; and in truth when we associate with the discharge of this fluid, emphatically pronounced by the Scriptures the life of man, the thought that with it rushes forth the subtle essence of life, it is not wonderful that the stoutest heart should quail from being instrumental in opening its flood-gates with the risk of not being able to arrest its discharge. For many ages imperfect were the modes of arrest- ing the flow of blood—the old surgeons used pres- sure, useless styptics, charms and incantations, and the cruel and often uncertain application of the red hot iron, called the actual cautery. From this prac- tice they have been sarcastically called disciples of the Ghebers of Persia, or fire-worshippers, and as an eminent surgeon observes, they ruled mankind with a sceptre of fire. * They avoided many operations, and permitted the uninterrupted progress of various most horrible affections, terminating in the death of the unhappy patient, for fear of the necessary loss of blood. There was an ingenuity in cruelty, in invent- ing burning irons; some surgeons had six, others seven, others ten different kinds of burning irons. They used them in wounds, and extirpation of tumours—for instance, cancer was directed to be re- moved with a red hot knife, which sears as it cuts, * Vide John Bell’s Principles of Surgery, vol, 1, page 211. 8 or with a knife of wood soaked in aqua fortis. In the ordinary bleeding from wounds, so common was the practice of using the cautery that it became a subject of retort of one of the advocates of a milder mode to the attacks of one who used the cautery. He says, ‘if sir, in a siege or in the assault of a city, where hundreds of soldiers have their limbs shat- tered, you should choose to cauterize with burning irons, you would need a page to run backwards and forwards with your irons, and furnaces to heat them in, and I should little wonder, if in the end, you were to be dragged out and stoned, as happened to Agatheus one of the earliest surgeons of Rome.5 But the benevolent feelings of our nature, gladly impel us to turn away from the rude state of sur- gery, to one marked by brighter and happier colours. There arose among men, one of those master-spirits, the product only of an age, who revolutionized surgery by a plain and simple discovery. He pro- tested against the prodigal use of the cautery, and proposed as a safe, certain, and mild mode of slop- ing bleeding vessels, the use of the ligature, or to tie a small cord around the mouth of the open vessel. This is one of those remarkable truths which com- pletely change the face of any science. Of its value you can well judge after the narration of the cruel modes in use before his day—and of its preciousness in practice every surgeon is sensible. But how was this great improvement received by the contempo- raries of Pare, the inventor. He was reviled and 9 persecuted. He was called rash, presumptuous, and for venturing to condemn the cautery—and he was reproached, as setting at naught the authority of the ancients, and teaching without any authority, without any knowledge, without good sense, some new method of his own, of tying arteries and veins. He was called harsh and opprobrious names, as Car- nifex, executioner, and the college of Paris, brought down its thunders upon him—so did his contempo- raries treat the father of French surgery. Gentle- men, why is it that man, too often like the ill-temper- ed cur, bites the hand offering kindness ? Why is it that in all ages, we find examples of the self-denying benefactor of his species, either by his labours or discoveries, reviled and persecuted ? What miserable perversion of human nature is it, that causes man- kind to fail down and worship the blood-stained con- queror, who uses them but as instruments to elevate himself, and strew their bones over the earth; and yet when a human being appears among them, self- denying, ever engaged in deeds of mercy and kind- ness, bringing blessings on them and their children, they are often the objects of dislike and hatred. And it is a fact deeply engraved on the blackest page of man’s history, that when the personification of kind- ness and goodness appeared on earth, they crucified him. But I did not bring before you the character of Pare, as an object of grateful remembrance, as one of the fathers of our art, but to place some points of his character in strong contrast with the host of 10 individuals who covet knowledge for the advance- ment of their own selfish views of exaltation alone. He did not come before the world claiming merit for this discovery, but with a humility and piety worthy of praise, says, ‘for the good of mankind and the improvement, and honour of surgery wras I in- spired by God with this good thought.7 And we cannot but feel persuaded from a consideration of his character, that he applied for aid to the fountain of knowledge and power. But Pare does not stand alone for confidence in the source of all knowledge. Wiseman, the father of English surgery, affords another memorable example of a submission to the will of Providence, and of placing all the honour at his footstool. Let any one read the introduction to his celebrated chirurgical treatises, and there will be found abundant evidence of the fact: for instance an extract or two may not be out of place, as the work is rare and not easily procured. He says, ‘he that shall duly consider the deplorable misery of mankind, and how much it wanteth relief in such multitude of instances must needs acknowledge us to be what antiquity hath long since called us, viz, the hands of God. In alluding to his work being com- posed under the pressure of twenty years sickness, so far from speaking in a repining and murmuring spirit, he says, ‘it hath pleased God, by casting me in such a condition to give me an opportunity of reading and thinking as well as practising. Both of which are necessary to the accomplishment of an 11 author, but indeed of a chirurgeon.* I cannot be so uncharitable to my brethren as to wish them the like sickness to oblige them to the like retirement for contemplation and study.5 In bringing forward the names of Pare and Wiseman, as proofs that they are exceptions to the oft repeated charge against our profession of indifference to religious feeling. I think I may safely add to these two, that of the father of American surgery. I do know that the concerns of a future world have been to him an object of anxious importance for years. From this fact let us draw a lesson of instruction more precious than rubies. That after the immortal spirit had conquered the fields of earthly wealth, arrived at the summit of professional fame and there remained solitary and alone on that lofty pinnacle, that it had made the salutary discovery that this world could not and it wras never intended to be for the full satisfaction of the soul. Gentlemen—l think myself happy in being able to claim the names of Ambrose Pare, Richard Wiseman, and Philip Syng Physick, the fathers of French, English and American surgery, as exceptions to the charge of indifference to reli- gion among physicians. These alone will outweigh thousands of those, ‘Content to feed with pleasures unrefined. The lukewarm passions of a lowly mind. Who mouldering earthward reft of every trust, In joyless union wedded to the dust; Could all their parting energy dismiss, And call this barren world sufficient bliss.’ * Eight chirurgical treatises, by Richard Wiseman, sergeant chirurgeon to king Charles the Second, London, 1696. 12 But to continue the progress of surgery, since the application of the ligature and the improved condition of anatomy and physiology most rapid have been its advances. Operations of the most daring character have been performed and with the saving of many valuable lives. To bring before you triumphs of surgery would consume much time, even w7ere it in place. It is familiar to all that it is the peculiar and honoured office of this art, ‘From thick films to purge the visual ray. And on the sightless eye-balls pour the day, The obstructed paths of sound to clear, And bid new music charm the unfolding ear; The dumb to sing, the lame his crutch forego. And leap exulting like the bounding roe.’* These are among the triumphs of our art, but they involve merely the restoration of the senses. But still they receive the deep gratitude of the human heart, as proved in the well known instance of the boy operated on by Cheselden; whose grati- tude was so great, that he never met him for some time without tears of joy in his eyes and other marks of affection, and whenever he did not come at the time expected cried from disappointment. I never found on record but one instance where such servi- ces were not acknowledged with gratitude. It is related that a man in Germany, became blind shortly after he was married to a young and beautiful wife. For twenty long years he groped in darkness, shut out from the light of heaven ; during all this time his wife attended to him with all a woman’s devo- *Altered from Pope’s Messiah. 13 tedness and affection, anticipating all his wants and watching over his unprotected condition. At the end of this time a distinguished surgeon visited the neighbourhood. He kindly offered to perform an operation to restore the sight, the poor man gladly accepted the offer, it was successful, as soon as the light of day beamed upon his eyes, he asked eagerly to see his wife. She was placed before him. He denied her identity, but wdten she spoke he recog- nized the familiar voice, which had been the delight- ful music to his ear for many a weary year. He was then convinced of the fact. But alas, ‘dime’s effacing finger had swept the brow where beauty lingers,5 the change had been made in those features which must come alike upon all the homely and the comely. Ah ! said the poor man to the surgeon, you have given me the blessings of sight but destroyed my happi- ness. The beautiful object of my earliest love which daily rose before my mind, cheering my recollection is gone for ever, and I never more can be happy. This, gentlemen, is the only instance, where so great a benefit was not met with corres- ponding gratitude. But these are the minor triumphs of surgery. It can point to others more glorious and important, which concern those diseases which more directly involve the risk of life. I will not bring before you dread cancer, casting its fibres into the very centre of the living body, and gradually causing the death of the unhappy victim. 14 But the value of surgery is more distinctly shown in that form of disease called Aneurism. This dis- ease is thus marked.—A patient observes a small swelling, say on a limb or the throat. He presumes it is a trifle. He feels but little inconvenience; except the slight deformity; and that he sometimes conceals by his dress from observation. But as has been well observed; the tumour which he hides under his side-lock or cravat; is perhaps; at no distant period; to cause his death. He pursues his usual avocations; it gradually enlarges and involves im- portant organs; at length the skin gives way, a torrent of blood rushes forth; and the unsuspecting patient is dead in little more than the twinkling of an eye. Here is the proudest trophy of surgical skill—a patient thus affected; applies in time to a surgeon. By certain marks he rarely fails to recog- nize its dread character; but then horrible is the task to rouse him from his dreams of fancied security. When we tell him with pain and sorrow that he has a disease; as trifling as he may think it; wrhich if permitted to go on in its course is inevitable death. He laughs incredulously; ‘what, doctor■, do you mean to jest with me, to make me believe that that little swelling is going to take my life. Oh no, you must be quizzing.s When with regret we explain the structure of the parts, and prove to him that that little swelling, wTich he deems unworthy of notice, is the enlargement of one of the great blood-vessels which will go on to increase from the powerful 15 action of the forcing pump (the heart) which drives the blood in rapid waves through its channel. Then indeed the truth flashes upon his mind with stun- ning force, and he not unfrequently almost faints from the sudden conviction thus forced upon his mind, that the grave stands ready to open its jaws to receive him. Then he exclaims, buy God ! doctor, is there no hope, can you not do something to arrest this disease and save my life.5 Now comes the noble and glorious triumph of our art. How does the heart of that unhappy man dilate with hope and joy, when we explain to him that there is an operation simple in its character, it is true often difficult in execution, which will close up forever that faulty vessel and repair the injury inflicted by disease. It is done, and many are the cases on record of its entire triumphant success. I remem- ber a remarkable instance in which this fatal disease wTas singularly detected. A printer in a neighbour- ing city, engaged in setting up the type for a work on surgery, as his eye glanced over the subject of aneurism, it struck him that a tumour which he had on his person, answered to the description of that disease, he showed it to his family physician. It was too true, he was operated on by a distinguish- ed surgeon, a near connection of Dr. Physick, with complete success. But the greatest triumph of surgery in the present day, is in the diminution in the number of operations. In the cure of disease without resorting to what should be the last resort, 16 the knife. I thus announce a fact which will doubt- less cause a thrill of pleasure in the breast of all who hear me this night. None of us know the day or the hour when disease may overtake us, and there is such a natural horror at coming under the knife of the surgeon, that this information must be well received. The best surgeons are occupied in close study of the means of preventing the necessity of operations, or inventing modes and instruments by which pain may be diminished and safety, and quick- ness ensured. A distinguished surgeon of London, the successor of Abernethy, Mr. Lawrence, says, Tt is a great mistake to suppose that a surgeon is always employed in operating, however extensive his practice. It is the boast of modern surgery, to have diminished the number of operations. I speak within limits when I assert that there are not so many operations performed now by one half or two- thirds, as when I first began the study of the pro- fession.5 Similar testimony is given by another distinguished surgeon, Wardrop. This, gentlemen, is the result of the improved knowledge of disease. Many a limb is now saved which would a few years since have been certainly cut off. Many a terrible operation is now prevented, which it for- merly would have been thought criminal and a want of operative skill to have declined. That this result so gratifying to every benevolent heart, is a greater proof of surgical skill than the mere operation, no one can deny. I have heard Dr. Physick say, ‘that 17 any butcher could cut a leg off, but that it took a surgeon to save it; and that he considered it much more creditable to him to save a limb than to am- putate it, however skilfully it might be performed.’ The public who are the operatee (to make a word) will rejoice at such an opinion from the first surgeon of our country, but the operators will not in all cases agree with it. Something must be pardoned to the weakness of human nature and the love of glory, for a brilliant and grand operation is in our profes- sion what the gaining a battle is to the military chieftain. In the general improvement of surgery, we feel it due to our country to assert that it is not in the rear rank. The Edinburgh Review, some years since, asked the taunting question, Tn the four quarters of the world, who reads an American book, or goes to an American play, or sees an American picture or statue; what does the world yet owe to American physicians and surgeons? For the ques- tion relating to the general improvement in the arts, we could easily point to the success of our country- men; but to the latter wre can give a most tri- umphant reply. We can appeal to the fact, that all the great operations in surgery have been performed in this country with a success fully equal, and we believe in some cases superior to that of Europe. In proof of this assertion we bring the testimony of Velpeau, a surgeon known over the world by his writings, who pronounces the success of some Ame- rican surgeons in a certain great operation, as asto- nishing, and asserts that the success of a distinguish- ed surgeon of our own city in one operation, was in a greater ratio than that of the celebrated Dupuy tren, the boast of France, and called the Napoleon of surgery. The boldest operation ever attempted by man was performed by Dr. Mott, of New York, who came nearer the heart in an effort to save the life of a fellow creature, than any mortal before his day. Gentlemen, feel emulous of such noble triumphs. Enough has been done a thousand times over to falsify the charge of Buffon, that mind and body degenerated in our country. Why may we not equal and excel our European brethren ? Have we not the same natural powers? Cannot the in- dustrious student meet here with advantages for the study of disease, and the means of practising opera- tions which will just as well fit him for the active duties of life?* A charge of cruelty has been brought against surgery. This is a serious charge, and one which * These remarks are not made in the illiberal and carping spirit of re- proach. We must in justice say, that a distinguished journal of England has disclaimed the spirit of the Review, as applied to American medicine and surgery. And we hail the increasing disposition in all the journals of Europe, to do justice to the efforts of American physicians and surgeons. But we use the argument merely to arouse the spirit of the young members of the medical profession, to a noble and generous emulation of our elder brethren, in the great cause of human benevolence. We point them to the bright examples in our own country, as proof of what energy and industry can accomplish, to the names of Gibson, Mott, Dudley, the Smiths, Harris, Randolph, Barton, McClellan, Geddings, Jameson, Stevens, Warren, and others. The contribution of American surgeons to the improvement of that depart- ment, will we trust be collected and published at no distant day, we know that there is one individual who had undertaken this duty to assert the honour and reputation of his countrymen. 19 must not be permitted to pass unanswered, particu- larly as I know it lurks in the minds of the gentler sex, by whose influence all must acknowledge that this world is ruled. Is that cruelty when a part is mortified and dead, dragging the patient down to the cold grave, that by a speedy operation, restores to health and the blessings of life? Is he cruel who removes from the patient the cause of suffering, which has been torturing him for years ? Or when from' accident, the life-blood is rushing out like a fountain, ties the vessels, and when the pallid countenance, the quivering limbs denote the near approach of the last enemy of man, puts aside the grasp of death just ready to seize his victim. No, gentlemen, it is the noblest manifestation of moral feeling and courage that nerves a man up to the trial—who, when all around are alarmed, and pale, and anxious, calmly, but with a beating heart, keeps down the rising sigh, dashes away the starting tear, and suffers and en- dures all the terrible struggles of contending passions within, cuts his way through appalling dangers to safety and to life. Who, that ever has seen that great surgeon, Dr. Physick, perform an important operation, while look- ing at the lines of that face, fixed as the monumental marble, the tense lip, the keen but calm eye, would suppose, that under that cold exterior there rolled the flood of contending feeling which almost unnerved his existence. Who would for a moment imagine, that, that cold, stern, and apparently unfeeling man, who heard not, or heeded not; the cries of the patient writhing under his knife, had passed part of the previous night walking up and down his room, groaning and troubled in spirit, suffering from the sensibilities of his nature. Yet, such Ido know from members of his own family to be the fact. The charge of cruelty as applied to him, has been so well met in some most touching lines addressed to Dr. Physick, as a token of gratitude for saving by his skill, the life of a beautiful and interesting lady, that I feel, I shall receive thanks for introducing so beautiful a gem before this audience, after some pre- vious verses, alluding to the number he had relieved by his skill. ‘But thou must remember her. The pure, the calm, the beautiful, the mild; Aye, e’en now, her name thy pulse would stir. For thorf did’st love, and soothe, and call her child. They say, thou’rt cold—unlike to other men, A snow-crowned peak of science towering high. Above the heart’s warm, soft, sequestered glen, And flashing sunset glories on the sky. Who say so—know thee not, nor can discern. Beneath thy sage, professional disguise. How deep the feelings, he whom they call stern. Hides from dull heads, hard hearts, and careless eyes.’ Is it not upon record, that the celebrated Chesel- den states, that whenever he came to the perform- ance of a critical operation, that such was the sinking at the heart, and the depression of feeling under which he laboured, that he was almost overcome, and that it was his invariable custom to seek aid from 21 On high by ejaculatory prayer just before operating. It is natural to feel such emotions: when the awful thought passes through the mind of the operator, that the soul lies like the imprisoned bird with folded wings in that frail body, and that by his agency or a slight slip of the knife, it may be let loose from its prison, and sent with all its imperfections on its head before the judgment seat of God. But such men as Physick, and Cheselden, and surgeons in general, are not cruel. It is true, the sickly sentimentalist who would weep floods of tears at the fictitious suffering of the heroine of a novel, or faint at the smell of a rose, may accuse the surgeon of cruelty. But we assert fearlessly, that the best proof of feeling and true kindness of heart is that, which impels a man to overcome in his own breast all the natural horror at such scenes, all the disgust they inspire, and en- dure all for the great object of relieving suffering, or saving the life of a fellow being, although he wrere as loathsome as Lazarus, at the rich man’s gate. To the dandy and the exquisite, there are subjects in our profession which receive their disgust—but it is the god-like object of doing good, which sanctifies and ennobles our calling: that it is which sheds a halo of glory around it, and decks the brow with the unfading laurel of benefactor of the human race. But I grant you, that the surgeon is cruel, who, with a mean and selfish eye to his own advancement in reputation and practice, will operate on the unfor- tunate patient when it is not absolutely clear, that it is right to do so, as the only alternative between prolonged suffering, life or a painful death. But for the honour of human nature, may we not hope that there are few such, so lost to the proper feelings which should animate noble and benevolent hearts. Gentlemen, in choosing the profession of medicine have you counted the cost. Have you duly consi- dered, that its duties require the noblest qualities of human nature— kindness—self-denial—generosity— courage to dare all for the good of a fellow creature; the reproaches of men—exposure to every hardship, the howling tempest, and the beating rain, and what is the reward ? often but little or nothing. But I check myself, you are, it is true, often met with ingratitude for the most important services—witness the instances familiar to all—the pecuniary recom- pense small as it is, grudgingly given or absolutely disputed. But there is a higher and noble reward which ever attends services thus performed, an approving conscience and sweet peace of mind which the world cannot give or take away. But it is time enough to look forward to the prac- tice of the profession; at the present time you have considerations of a different character—you are now at a most interesting and critical period of your life. Bear with one who has preceded you but a few years, if with all the energy of his nature, and with all the sincerity of a heart devoted to his profes- sion, and to his younger brethren, he endeavours to 23 arouse you to the necessity of instant and unwearied devotion of your time and talents to its service. I have endeavoured to point out in the most impres- sive manner the heavy responsibility which rests on every physician—now is the accepted time for a due preparation to meet that responsibility. You cannot shrink from it—as soon as you announce yourself as a candidate for practice, you give a pledge before the world that you are qualified to receive its patron- age, and to have entrusted to your care the lives of those most dear to their hearts. There is no time to be lost. Your first case in practice may be one which involves immediate danger to life. You must act, and act quickly. Upon this case may rest your suc- cess or failure. Gentlemen, if you would not in that awful hour of trial feel the torture of a wounded spirit. If you would spare yourselves agony almost insupportable, let me urge upon you daily, nightly, and hourly, unremitted attention to your duties here. The time of medical study is confessedly so short that it must be criminal to abstract any portion of that precious time. Let me implore you, as you value your peace of mind, your success in life, to spend your time well now. How fleeting is time. Does not the moralist seek throughout nature for the most transitory emblems to typify the march of time. •It is a hand-breadth.—’Tis a tale, ’Tis a vessel under sail; ’Tis an arrow in its flight, Mocking the pursuing sight.’ 24 Believe not those who would delude you with the old saw, that you can make up for lost time. It is not true. Be assured, that if you once permit the present time to glide from your careless grasp unim- proved, if you suffer the angel to go without having blessed you, there will be no opportunity of prepar- ing the armour and sharpening the sword, which is to cut your way through life, when you are in the din of the battle, and the thickest of the contest for this world’s riches and honours. JNow is the time for laying in stores for the voyage: you will have lost the opportunity when stern necessity unfurls every sail to urge you on in your destined career. There is no standing still—there is no bringing to, in the wide ocean of life—you are driven before a resistless wind, which will, sooner or later, convey you to your destined port. Every portion of life has its allotted duties; they cannot be interchanged, or one supply the omission of the other—and, whatever may be your natural talents, remember, that the great mora- list has said, ‘that negligence and irregularity long continued, make knowledge useless, wit ridicu- lous, and genius contemptible.’ Gentlemen, do I appear too much in earnest. Can I have the feelings of a true friend, and not seize this opportunity of impressing you with truths which will have a con- trol over your future destiny. Do I not know every step in the career of a student of medicine. After a due period of preparatory study, he goes to a city to have the advantages of lectures and demonstra- 25 tions, denied him in his native town. How afflict- ing is the parting with parents and friends. Many are the tears at his departure, many are the prayers put up in his behalf, that the great Keeper of Israel who neither slumbers nor sleeps, would protect and watch over him in the dangers to which he often goes, as a lamb led to slaughter. The young man while the impress of a mother’s kiss is yet in his mind, is watchful over his conduct, but by and by the harpies which infest large cities and go about roaming for their prey, find him and he often falls a victim. How many young men do I know in my experience to have been ruined by a winter’s resi- dence in a city, ostensibly to attend lectures, but oftentimes missing a large number of them. What should be our opinion of a young man who has wasted the hard earned means, not in purchasing that knowledge more valuable than the diamond, but squandered it in riotous living. Ido think that part of the fault lies at the door of the medical teacher. He should not take the selfish ground that the young men are of no interest to him, except to pay for his ticket and be qualified for examination. No, in my opinion there is a close and affectionate relationship, which should ever exist between teacher and pupil, the warning voice should ever be heard giving friendly monition of the breakers and unseen rocks ahead which will wreck his frail vessel. He should be their friend and counsellor in sickness and in health. For myself, I shall endeavour to dis- charge my duties conscientiously, and no young man of my class shall reproach me in after life, that he was not forewarned if not fore-armed. I know that in general the student must have some relaxation and of the very best is good so- ciety, to which every well-bred gentleman can gain ready access in our city, but still I feel bound con- scientiously to say, that the duties compressed into four months, are so many that the student who feels desirous of deriving full advantages cannot go into society, particularly his last winter. Let no one believe that this advice is prompted by that cold- ness of heart which my colleague charged me with last night.* No, gentlemen, my advice alwaysis to devote much attention to the better portion of crea- tion. I feel it necessary in reply, to say more than perhaps a grave professor should do, but I should think it very impolite to go through a whole lecture without noticing so large a portion of my auditory. Who is there that should be more willing to pay a just tribute to their merits than the physician. Have I not seen them submit with unflinching for- titude to the most terrible operations, such as the lords of creation would yell and groan most piteous- ly at. Much is said of the courage and bravery which impels men into the battle field. Is there not some exaggeration here? Do they not take good care to excite the men by music, sometimes whiskey, and all the adventitious aids to rouse the *A remark made in mere badinage. 27 natural bull dog feeling in his breast. You pen him up in a ship where he cannot run, and then what prodigies of valour he performs! Yes, he is very brave when all those helps are given him. But all experience of surgeons declare, that in calm forti- tude to endure pain the palm must be awarded, not to the lords but the ladies of creation. No one feels more powerfully than a physician who sees it daily in his practice, the blessed and balmy effects of female influence. How it smooths the pillow of sickness, and sheds its benign and heavenly power over the heart bruised by affliction. We do indeed regard them as our ornament and pride in prosperity, and solace, and consolation in adversity; supporting the fading hope and binding up the broken heart. Man too often rude and selfish, requires every inducement to prompt him to deeds of kindness and charity; but they act from the spontaneous overflowings of a feeling heart. Man too often deserts the companion of his prosperity, when the billows of adversity have broken over his fortunes; but they never leave the side of him, they have honoured with the rich treasure of their affec- tions, but cling to him with an increasing affection through evil report and through good report, and as has been beautifully observed* ‘if the whole world desert him, you are to him the world.5 In all the * See Washington Irving’s beautiful tale of The Wife,’ for a just tribute, *most admirably expressed. afflictions of life you are the harbingers of brighter and happier days and your smiles and countenance are indeed ‘As the rainbow to the storms of life. The evening beam which smiles the cloud away, And tints to-morrow with prophetic ray.’