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	INTRODUCTORY	ADDRESS	
			
	TO THE CLASS	OF	
RUSH  MEDICAL  COLLEGE,
BY PKOFESSOK J. V. Z. BLANEY.
                   IK
Delivered November 7, 1860.
          CHICAGO:
J. W. HYATT, JB., BOOK AND JOB PB1MTKB, 23 LAIUC STRUT.
           1860. 
CORRESPONDENCE.
                                            Chicago, Nov. 8, 1860.
Prof. Jas. V.  Z. Blaney:
    Dear Sir: The undersigned, having been appointed a Committee, by the
Class of Rush Medical College, to return thanks to you for the able and iater-
esting Introductory  Address,  delivered  Wednesday evening,  November 7,
1860, would respectfully solicit a copy of the same for publication.
                              Yours, respectfully,
                                    E. A. CLARK, Ch'n,
                                    H. S. BLOOD, Sec'y,
                                    S. S. BUCK,
                                    A. M. PIERCE,
                                    G. C. McFARLAND,
                                    H. M. MINESINGER,
                                    I. B. WASHBURN,
                                                     Committee.
-••»•-
                                            Chicago, Nov.  20, 1860.
To  Mjssrb. E. A. Clark, H. S. Blood, S. S.  Buck, &c.:
    Gentlemen: Your complimentary note has been before me for some day.-,
and I have delayed to reply, in the hope that I  should find time to rewrite the
address you ask for publication, whioh, written  at a time when much pressed
by other duties, I feel is  scarcely fit for  publication.  Finding myself unable
to command the time to do so, I accede to  your request with reluctance.
    Please present to the Class my thanks for the  compliment conveyed in
your note of the 8th inst.
                                 Yours, Truly,
                                                Jas. V. Z. Blanzy. 
INTRODUCTORY  ADDRESS.
Gentlemen of the  Medical  Class:
  This evening inaugurates the  Eighteenth Annual  Course
of Lectures in Kush Medical College, and you are assembled
to receive from us, your instructors, and we  to offer to you a
welcome to our institution.   This welcome we now most cor-
dially extend you, and while so doing, we cannot avoid con-
gratulating ourselves and the friends of the Institution upon the
fact, that the number of students in attendance upon the pre-
liminary course just past, and present on this, the first day
of the present session, is much greater than on any previous
year since the foundation  of  the institution.  This fact we
cannot but accept as an earnest  that our previous efforts, to
afford to students  of the  Northwest a  thorough course of
medical instruction,  has met the approval  of the profession
at large, as well as of those of you whose familiar faces have
been before us in previous  sessions.  While feeling this to be
a reward for the past,  we are also  stimulated to  further
endeavors to merit the approbation  of those whose favorable
opinion we desire to secure, as those most capable of judging
our efforts.
  Prepared somewhat to anticipate a large class at this ses-
sion by previous correspondence, we have, as far as  prac-
ticable,  improved our means of demonstration, and made all
possible arrangements to  secure your comfort and conveni-
ence during the course of instruction  just opening,  and we
■"/v"; 
4:
confidently hope that  these arrangements  will contribute to
your advancement in your studies, secure your uninterrupted
health during the session,  and meet your approval  at the
close.
   Selected by my colleages  to offer to  you some words of
advice and counsel to  direct your course of study, I select as
the subject of a short  address, " The elements of success and
causes of failure in the character and habits of medical stu-
dents."  In the short  time within which I must condense my
remarks, it cannot be  expected that I should give more than
a faint outline  of so  copious a theme, but I hope to be able
to exhibit a few of the dangerous  reefs and shoals which but
too often  make  shipwreck of the brighest hopes  and most
confident anticipations.
  In  the  life of eyerj man there is "an  epoch,  which more
than any other, determines  for him the question of success or
failure. To most  men, probably, this arrives at  the time
when they make choice of  the business or profession which
it is their intention to pursue for the remnant of their allotted
period of earthly existence.   At this period you, gentlemen,
have all arrived, as is  proved  by your presence here with the
object of commencing the study of an honorable profession.
The propriety of the selection you now make, and the resolu-
tions  now  determined,  will perhaps more than any  other
causes, influence your  future success or failure.  Does it not
then become you to pause upon  the threshold, and ponder
seriously the responsibilities you  are about to assume, and
calmly and dispassionately  look full in the face the difficulties
and discouragements which are liable to beset your path at
every  step of advance?  Were you  merely  about to enter
upon the study of the medical profession, without intending
to pursue  it as  your  life-long avocation,  the  remarks  I am
about to offer would be needless.  No profession offers in its
prescribed  course of  study more allurements than  that of
medicine.  It may truly be compared to a vast and beautiful
field  glorious in  perpetual  sunshine, and gemmed  with
myriads of flowers, both gorgeous to  the eye and delicious to
every  sense^ waiting only the appreciative mind to quaff its 
5
beauties and  revel in its ever-varying delights.  Were this
all;  were there no beyond; I should have no word of cau-
tion  or warning to offer, but I would invite you to enter its
glorious precincts  and regale yourselves to the full, without
fear  of being cloyed with profusion, or disgusted with reple-
tion. But beyond these delightful fields of study lie the
rugged  steeps  and weary  ascents  of the  stern  realities of
professional life, and through and beyond these you must
pass to attain the  laurel and the bay which is to reward a
well spent life.  To gain the goal, you will have to leap the
slough  of despairing  confidence, shun the  allurements of
other and more agreeable paths to fame, and avoid the slush
and  mire  of  empirical  systems, which,  like the  Dismal
Swamp, conceal their fatal depths of ooze and  mud  with  a
thin  skim of velvet moss, which seeming luxuriously soft and
easy to  the foot, but treacherously conceals the alligator and
the  adder, and once trusted with  his footfall,  permits the
traveler to sink beyond recovery.  These, and  a thousand
other difficulties, beset the path,  and fortunate and brave is
he who, at the end of a successful life, can look back and say
with truth, I have  overcome them all.
  There is a  trite saying, that " forewarned is forearmed."
If this is true, would it not be a false and  short-sighted gen-
erosity  which  would  permit a young  man to enter upon  a
journey beset with difficulties, which  threaten to  prevent its
accomplishment, without informing  him  of  its inevitable
perils, preparing him to meet them with  courage, and fur-
nishing  him with  the weapons  for his defence.  Yet such
would be the course of your instructors did they permit you
to enter upon the study of your profession  without sounding
a single note of warning.
  Suppose that you were  about to undertake a journey in
performance of a responsible mission, what inquiries should
you make before you entered upon  your duties ?  First, you
would inquire  into the nature of the mission, and  the kind
and amount of responsibility you  would assume.  Next, you
would ask yourself whether  or not you had  the ability to
perform the  duties devolving upon you, and to answer this 
6
you would need to know the difficulties which would present
themselves in the way of success.  Lastly, you would wish
to determine the course of conduct necessary to pursue in
order skillfully to accomplish  your purpose.  Precisely such
should be the course of self-examination  pursued by each of
you just entering upon a journey which is to last your whole
life long, and upon a mission,  than which few that a man can
be called upon to perform, are more important, more arduous,
or require  higher qualities  of  mind or more mental  and
physical endurance.
  Let us pursue this course of inquiry and examine—First:
What is the nature, and what the amount  of the respon-
sibilities of the medical profession ?
  Gentlemen, if  you could be made fully to appreciate the
responsibilties you are to  assume as medical men and yet
feel willing to go forward in your course, you are brave men.
Y©u have before you  no  life of ease or gaiety, but one of
severe mental application and physical  labor, of constantly
recurring trials of courage and  trials of  patience, of profes-
sional emulation and   of non-professional  criticism, of mis-
conception,  of reproach  and of  ingratitude, and  with  all
this  you have the perpetual burden of the responsibility of
human life.   Did you ever happen to be in a court of justice
when the twelve men, to  whom  the  law had submitted the
decision of a charge of murder, came into court with their
verdict  of guilty stamped  on their pale faces ?  Have you
seen the prisoner at the bar, stained perhaps  with  numerous
crimes, strain with haggard but eager gaze upon the foreman,
from whose lips were about to issue the  words, to him, of
life  or death ?  Have  you seen that sea of human faces, pale
and  serious, riveted with breath restrained to catch the single
word which dooms the wretched man to the scaffold, and yet
failed to see, that each of those twelve men felt himself bur-
dened with the  responsibility of a human life, and that the
burden was almost more than he could bear?  And yet every
day, nay, almost every hour of your life,  as a practising phy-
sician, you  will assume alone,  not sharing with  others  a
responsibility equally great,  and  that  of lives not justly 
7
forfeited by crime, but lives which, if preserved, might be of
the highest use to our common humanity, lives  of the pure
and innocent, lives in which are bound up all the affections,
of whole families, lives of the great and good.
  Do you  appreciate this burden  you are about to assume ?
Then pause and ask  yourselves if  you are, or ever will be,
prepared to take this yoke upon you.   If not, then turn back
while yet there is  time  and find your proper place in other
paths of life.  If yea, then, with God's help, acquit yourselves
like men!
  Do not presume that, by these remarks, I would discourage
you from pursuing the profession of your choice.   Not so.
I only wish that you should fairly  see and appreciate the
worst, that you may gird yourselves the more  strongly for
the contest, and be fortified in your foreknowledge, and thus
prepared in advance for the struggle  which sooner or later
must  come. But these are not the sole responsibilities which
will rest upon you as medical men.  You  have  duties to the
profession itself, to maintain its honorable character before the
world as enlightened, liberal, benevolent  and  progressive.
And as every individual is, in his own person, a representa-
tive of the profession at  large, his character, his proficiency
and his labors for its advancement, or his neglect thereof,
all  count in the estimate made by  community of the pro-
fession itself.  No man  can accept of the rights, privileges,
and position conferred upon him by his admission as a mem-
ber, of any association,  without tacitly acknowledging the
claims of such association, that he will sustain its honor and
contribute to its advancement.  As this claim is enforced by
no  penalty, but is the  result  of  reciprocal interchange of
tacit pledges, it is the more strongly  binding upon the honor
of the individual, and can never be ignored without disgrace
and loss of self-respect.  It will not do to close your  eyes
to these claims  and  fold your  arms in negligent contempt,
for your own consciousness will  perpetually urge them upon
notice, and you will be self-condemned, as a useless drone, in
the busy hive,  peopled with  your active  and  successful
compeers. 
8
  With this brief sketch of your responsibilities, we pass on
to the next inquiry—Have you the  ability, the powers  of
mind, and  the mental  training requisite to the performance
of these duties?
  Know thyself is the  most difficult of all knowledge, and
yet one of the most essential  elements of success.  Many
men live out their lifetime  without ever learning their real
capabilities, much less detecting  their deficiencies.   They
may consequently be straining every nerve in a direction in
which  they never can  succeed, while in other walks of life,
demanding different qualities of mind, they might with half
the effort distance their competitors.   And when we reflect
that the analysis of a mental organization, which should indi-
cate the qualities fitting a man for any social position, is so
difficult to  be made by  the oldest and wisest metaphysicians,
it is no longer a wonder that frequent fatal errors should be
made in the choice  of a profession by the young and inex-
perienced.  Again, as  no two  minds ever have or ever will
exhibit the same  combination  of  qualities and powers, so
nothing more than the merest sketch,  in outline, of the most
prominent  features, can be indicated to guide a young man in
his selection.
  In order  to attain  superior excellence in the  Medical pro-
fession, there are a few prominent traits of mind which are so
essential that I shall endeavor briefly to indicate them:
  The medical man should have quick perceptions, and the
faculty of comparison.   Many physicians, for want of these
powers, fail in diagnosis; the first  duty of the physician, in
every case to which he may be called.   Men differ very much
in this regard.  Some medical men seem almost to have intui-
tive perceptions, which  enable them to detect, and guide them
almost unerringly in the analysis of symptoms.   Such men
will make a correct diagnosis while others have scarcely seen
the outward signs, much less appreciated the train of thought
by which they have arrived at their conclusions.   The former
have a fitness for the profession which the latter can never
attain by the longest  experience.   It is only  by the con-
sciousness of the want of this faculty, which, it is true, is not 
9
acknowledged, but which would be a powerful incentive, that
I can account for the fact that some men who have commenced
their career in the right paths  and under favorable auspices,
have afterward chosen the easier paths of empiricism, where
diagnosis is unnecessary, and all that is required is to prescribe
for symptons  as  they arise, without  any reference to patho-
logical conditions or to the existence of causes to be removed.
This must be a very easy and  comfortable way to practice,
but*it appears to  me must be rather  unsatisfactory so far as
a consciousness of filling any enviable position is concerned,
for any old lady can take  up  the book,  read off the symp-
toms of headache  or toeache, and order the inevitable " nux,
pullsatilla, camomilla, or mercurius," and dose out the re-
quired number of little sugar  plums from the delicate little
vial.  It is all very plain  sailing, and those who prefer it
must be easily contented with such  rivalry as I have just
indicated.  Indeed, I am at a loss to discover what is the use
of the practioner at all where this is  all there is to be done.
But the worst rub of all must be the ever present concious-
ness  of being a  useless supernumerary in society, and of
being paid for usurping the province of those elderly matrons
who are always ready to give their services without fee.
  Accuracy in diagnosis may, of course, be acquired by care-
ful  study of symptoms and by experience, but there is an
immense difference  in  men in regard  to the facility with
which it is acquired, and with some there is a  total  inap-
titude, which, when discovered, should be sufficient to deter
him from further practice of the  medical profession.
  Decision of character and nerve are qualities which  the
medical man must possess  in a high  degree.  These, if not
innate, are seldom acquired, and the conscious want of them
should at once deter  any man from entering the arena of
professional life.  The want of  these qualities is so  evident
to  every one,  so easy  of detection by the patient and his
friends, that a want of confidence and falling off of practice
is  the inevitable  result, no  matter how favorable the other
conditions which ushered the young men into business.
  Nothing sooner begets a want of confidence in the skill of
                                                 2 
10
 a medical  man  than the appearance of wavering and hesita-
 tion.   This is  different from uncertainty in diagnosis,  of
 which, if he is doubtful, he shows  no want of decision or of
 nerve by confessing the fact and calling counsel.  This, in-
 deed,  it is his  duty to do, and  sensible people, instead  of
 losing confidence, will rather be  impressed with  reliance on
 his sincerity, and be more willing to trust  him again in seri-
 ous  cases.   Indeed, the  refusal  to call counsel, where the
 uncertainty, of the physician is discovered, leads naturally to
 the  supposition  that he fears  detection of some mistake,  or
 that he is conscious of his own  deficiencies and  fears the
 exposure which  an intelligent counsel would detect.  Though
 I would deprecate the unnecessary calling of counsel in plain
 cases where nothing is  to be gained, yet, where  the anxiety
 of the patient or his  family is  evident and  they appear to
 wish it, the attending physician should rather anticipate the
 wish of the  family, provided a  competent and respectable
 practitioner can  be  obtained.  If any  irregular man  is pro
 posed, respectfully decline to meet him, stating fairly your pro-
 fessional reasons for  so doing, and if it be insisted upon, retire
 from the case rather  than sacrifice your self-respect.
  The want of decision to which  I  refer is rather the result
 of a want of self-confidence, a fickleness of purpose, and an
 indisposition to  assume responsibility.  Where  this  is the
 consequence  merely of a consciousness  of  deficiency  of
 acquirement in the principles ©f the profession, or a want  of
 experience, it is  remedied in  time by  study  and practice or
 hospital instruction.   But where it is a vice of mental  organ-
 ization  it totally unfits a man for the  active duties of the
 practice of medicine.
  Nothing  can be more deplorable  than the condition of an
 undecided  physician when he has  to cope with an unusual
 form  of disease, or  has a succession of serious and difficult
 cases.   As  long  as he has only ordinary ailments to manage
 he gets on  swimmingly, but let one of those fearful epidemics'
occur, where the best informed and  bravest of the profession
are at fault, those times that try men's souls, and where is he
then?   Sickened, desponding,  faithless, in  regard  to  the 
11
principles of  his profession, he either falls himself a victim
to the disease, or he seeks refuge for his craven soul in  one
of the easy chairs of empiricism.
  That which I have termed nerve is no less essential than
decision of character.  It is, par excellence,  one of the  dis-
tinguishing characteristics of every eminent surgeon, and im-
plies firmness  of purpose, self-confidence, and confidence in
the profession, fearlessness in assuming  responsibility, great
power of will, and perfect self-control, and, while the surgeon
or obstetrical practitoner can only succeed when he possesses
these qualities in strong development, a lack  of them unfits
a man for all branches of practice.
  True, other qualities of mind, such as are essential to secure
success in any undertaking, are equally necessary to the med-
ical man, and however great, however grasping the intellect,
it  will find, in  this department  of study, full scope  for its
most  exalted  powers.  But the qualities I  have specially
mentioned, I consider as absolutely essential to every man, in
order that he  may  sustain even  a respectable position as a
practitioner.
  Having pursued thus far your  self-examination and deter-
mined to  pursue the study of medicine  as your profession,
you should then determine the conduct on your part neces-
sary to accomplish the study and most fnlly prepare you for
its practical duties.
  In  this connection I can only hope to offer a few hints which
may serve as  finger posts on your journey, leaving  minute
details to your own good sense for their suggestion.
  The first  suggestion I offer is the  necessity of  systematic
use of time.   By this I  mean the practice of setting apart a
particular time of day for a particular duty, such an hour for
a particular  study, such  an  hour for another  study, such an
hour for exercise, or out-door employment.  Believe me  that
by the adoption of this system you will accomplish immensely
more in a given time than you could  by attempting to study
without any prescribed system.   Of  course this system will,
at times, be unavoidably broken in upon by unusual occur-
rences, but if you are firmly determined to  carry out your 
12
system, you will succeed, with a large proportion of your time,
in working up  to rule.  Try it for a time, and my word for
it, you will soon be surprised at the  greater amount of read-
ing you will accomplish.  Nothing is more apt to grow upon
students than a vicious habit of unprofitable lounging, either
in each others  rooms, or in other lounging places.  Were a
record kept of the hours thus spent by many  students, for a
single year, it would scarcely be believed what an amount of
valuable time had been lost.   I do not, by any means, dep-
recate the occasional visiting each other  for relaxation and
rational conversation.  Indeed,  if the subjects of your studies
form the basis of your talk, within certain limits, such a prac-
tice  has its advantages,  by eliciting each  other's  views,
assisting each  other's  comprehension,  and impressing facts
and principles upon the mind by a familiar review.  These
visits  should,  however, only  be indulged in  during  the
hours devoted  to  relaxation, and respect  should also be had
to the  hours  of study  of others, that  the time may  not
be frittered away which  it was their intention to devote to
study.
  Make use of  little moments of interval occurring unavoid-
ably between your regular duties.   This is the secret by which
some  men accomplish so much  more than others.  Every
moment, even  an  interval of five minutes while waiting an
appointment, is  devoted  to reading, and in the aggregate of
years a vast amount of knowledge is acquired.   We are told
that a certain authoress of note, who was lady in waiting to
a queen,  wrote several  of her  most valuable works in the
few moments of each day that she was waiting the approach of
her royal  mistress.   In the case  of physicians and surgeons
of large practice, these little intervals occurring between calls
are the only times in which to  accomplish all the reading
necessary  to keep pace with the advance of  the profession
or write the notes of cases  or other  observations of value
which make up their public reputation.   This hint mio-ht
be considered trivial if it applied merely to the  loss of time
during  student  life, but  if we  reflect that the  habits then
formed are apt to cling to  a  man his  whole  life long  it 
13
assumes an importance which may determine the question of
mediocrity or superiority.
  Cultivate a habit of close  attention in the lecture-room.
This is important in view of the fact that your lecturers,
speaking for the most part extemporaneously, and giving to
you the result of their experience, will often, under the inspi-
ration of a moment of enthusiasm, throw out valuable sug-
gestions which may prove of immense  service to you in after
life, but which will probably never go  upon paper, and once
lost from inattention is lost forever.  Again, unless you be-
come  yourself a  public teacher you can never know how
much inspiration is given to a speaker by an attentive audi-
ence,  or how difficult the  effort to feel himself interested,
and do justice to either the subject or himself, when a portion
of his audience are listless, heedless, or perhaps attending to
something else, while he is vainly laboring to drive knowledge
into their resisting crania. The  question is often asked by
students  whether  it  is of advantage to  them  to take notes
during lecture time.  The  answer must be  qualified.  That
the fact of  taking notes  induces a  habit of undivided
attention to the lecture  there can be no doubt, and  if  the
attempt is only made to set down the heads of the discourse,
without trying to adopt  the  language of the lecturer, as a
general rule the result is  good.   The  notes  themselves  are
valuable  as a synopsis of the reading required to review  the
subject.  The objection to taking notes during demonstrative
lectures is this, that, while endeavoring to write down  the
remarks  of the lecturer the demonstration may be lost, and
of the two the latter is the more  valuable.   The distinction may
then be made between a lecture which is purely didactic, and
one which is mainly demonstrative; in the former the prac-
tice of taking notes,  if dexterously done, so as not to lose
one remark in  setting down  the other, is good, in the latter
more is liable to be lost than gained by the practice.
  The question may arise  with some in regard to the relative
amount of attention which it is desirable to pay to the several
departments of study during  each course of lectures.  This
query can only be answered with reference to the amount of 
                           u

previous reading enjoyed by each student.   If yon have
commenced the study of medicine but a short time previous to
your first course of lectures, it is desirable  that you should
pay more special attention to what might be termed the rudi-
mentary branches, viz: Anatomy, Chemistry, Materia Med-
ica and  Physiology.  Do not, however,  neglect a regular
attendance upon the  more advanced and practical branches,
for you will learn much from the demonstrations and teachings,
that will render your reading during the interval  between
your  courses  of  lectures  much  easier   of  comprehen-
sion  and  more  satisfactory.  Learning  also  the  practical
application of your  more  rudimentary  branches,  gives  to
them  an interest which  they would  not otherwise possess.
My advice then is, that  while you  attend  and endeavor to
learn  all  you can from all  the courses of lectures,  to which
you have access, let the most of your  time given to study
outside of the lecture-room be spent in the  dissecting-room,
or in the study of the rudimentary branches, so that becoming
thoroughly grounded in these you may be  the better able
fully to appreciate  the practical branches in your second  or
third course.
  If on the other hand you have had a pretty thorough course
of previous reading, you will find it to your advantage to pay
as much attention to one branch as  another.   Experience,
I believe, has fully proven  that attendance on one course of
medical lectures upon each branch is wholly unsatisfactory.
The first course gives to the  student merely  a vague outline
view of the immense field he  has to travel,  without permit-
ting  even  the quickest intellect to attain that complete and
minute  knowledge in detail, which is essential, in order that
he may use his  information  to advantage in  practice.   Even
the third course is  of great advantage to the best  read stu-
dents, and the remark is not  unfrequently made by gentlemen
of the profession, who after a greater or less number of years
of active  practice  have attended a full course of lectures in
a good medical  institution, that this last course was  far more
useful to them than those of their student period, not that the
lectures were better or more complete, but that they them- 
15
 selves were more  appreciative.  Do not,  gentlemen, allow
 yourselves to presume that any one of you makes an excep-
 tion to this rule.   You may have had an unusual amount of
 reading, you may be very quick of comprehension, you may
 have enjoyed unusual advantages  in the  office of your pre-
 ceptor, but let  not these  advantages breed  in  your minds
,the  self-conceit  that you are an  exception to the rule.  Be
 not  in haste to  graduate.   Thousands of practitioners now
 unable from the pressure of business  to  attend a  medical
 school for a single  session, would be willing to make almost
 any sacrifice to attain the knowledge they feel they have lost
 by not extending longer their study.  With many a man it
 is keenly felt to have been to him a fatal mistake to have
 graduated too soon, and to have made the difference with him
 between remaining for life an ordinary practitioner in a small
 village, or becoming a leader in some special department of
 the profession.
   The next suggestion I offer i6, to give as much  attention as
possible  to  clinical instruction.  I can scarcely hope in the
 short space  into which I must crowd my remarks to  be able
 fully impress upon  you the importance of the facilities offered
 to you for  becoming familiar with bedside practice.  It can
 hardly be exaggeration to say that a single case, thoroughly
 explained and  commented  upon by a competent  clinical
 instructor, advances a student further in diagnosis and treat-
 ment,  than  a hundred others seen in ordinary practice with-
 out  an experienced guide to demonstrate its features.   An
 experienced teacher, whether in the surgical or clinical wards
 of a hospital, will in the clinical lectures of a single session
 comprise in  a nutshell the experience of a long life of prac-
 tice, and that with a minuteness of detail and  accuracy of
 demonstration which impresses the subject in a manner never
 to be  forgotten.  The well  earned reputation of the  men
 connected with  prominent medical schools attracts to them
 the most serious and important cases which are only occasion-
 ally  found  in a  limited business,  but  when occurring and
well or ill treated go far to establish or depress the standing
of every  general practitioner. 
16
  In your clinical studies let me impress upon you the impor-
tance of acquiring a habit of minuteness  in the examination
of symptoms and in making comparison between the signs of
healthy and diseased conditions of functions.  First familiar-
ize yourselves  with  the normal  states  of  organs  and  the
normal performance  of functions,  by examining the pulse,
tongue,  breathing, sounds  of  the lungs and  heart, etc., of t
each other, or  of those presumed to be in good health, then
in the hospital  wards endeavor to  ascertain the aberrations
in the symptoms or physical signs which  mark the  presence
of disease.   Never feel satisfied  with the dictation of your
preceptor  that  things  are  thus and so, but try and perceive
for yourself  and record upon  your memory the  signs  or
symptoms with all their normal  and abnormal associations,
comparisons, and  indications.  Then, when  you  have re-
turned  from  yonr  clinical  lecture  make copious  notes  of
the lecture and of your own  observations.  If you  have
access to a library, study out in detail  all you can find bear-
ing directly or remotely upon the  case in hand.   In your
notes make references to all the authorities upon  the subject
which you  can  find, and, as often  as may be, make out a full
report  of the case as if for publication.  Submit your notes
freely to  the criticism of those who have more experience
than yourself in observation and in writing,  and are willing
to correct them, and thus you will  gain the habit of making
up notes of cases, and obtain  a facility of composition and
correctness of expression which will be invaluable to you in
after life, and go far to assist in effecting your reputation with
the profession at large.
   There is many a physician whose extensive practice and
unusual experience would,  if published, make for him a hio-h
reputation  at home and abroad, who remains in obscurity
and whose  results are lost to  science, in consequence of his
want of facility in writing and his indisposition to commit his
ideas to paper.
   Another hint—Never lose the opportunity to be present at
and assist in a post-mortem examination.  No  one of the
sources of information is more neglected by the profession at 
11
 large than this, the only means of attaining exact knowledge
 of pathological conditions, and of confirming or disproving
 the significance of physical  signs and symptoms of disease.
 Investigation in this mode is almost  exclusively confined to
 the physicians and  surgeons of hospitals, or the teachers in
 schools of medicine, when invaluable opportunities are con-
 stantly  occurring, in private practice,  which, if properly
 improved, would  do much to  increase  our  knowledge and
 advance the reputation  of the  fortunate  investigator.  One
reason for this neglect, I cannot but think, is due  to the fact
 that comparatively few general practitioners know how proper-
 ly to conduct a post-mortem examination ; or, if made, are able
to place a proper comparative estimate upon the  indications of
 disease or aberrations from the healthful appearance of organs.
It is during your dissections that you are to take your first
lessons in this direction.   Let no opportunity pass to observe
and  record upon the tablet  of memory, the  comparative
appearances of diseased and healthy structures, and to be-
 come familiar with  the symptoms corresponding to the cadav-
eric appearances.   Every advance in a direction not common
to the mass of your  compeers, gives you an advantage over
them in  the  struggle for position,  and widens the distance
between  you and the empiric, by whom all such exact and
critical knowledge, and all scientific inductions thence derived,
are not merely neglected, but derided.
  But, gentlemen, I will not longer detain you with advice,
which is apt, like legislation, to fail of its effect if there is too
much of it.  I will only detain you, in conclusion, to inquire
as to the objects you propose  and the aims you have set before
 you to attain in your selection of  the medical profession.  If
 wealth be  your object—if you have taken up the study of the
profession merely  as a business by which you expect to attain
a fortune  in a short period—I fear you have made an egre-
 gious mistake  No profession is in general so badly paid for
 the amount of study required for its attainment, for the men-
 tal toil and responsibility incurred, or the physical labor and
 exposure entailed in its pursuit.   The number of its votaries
 which ever make more than  a respectable competency as the 
18
legitimate  results of their  practice  is small.  The mass of
physicians, who have ever become wealthy, have made their
fortunes by other modes.   Only those who attain the summit
of fame and ambition, as the leading surgeons or physicians
of large and wealthy cities,  can boast of wealth fairly attained
in the practice of the profession.
   Obviously then to attain this, if it  alone be  your object,
the only sure and direct path is that which will  most surely
lead to the highest eminence  as a professional  man.  It is,
however, to be hoped that a large proportion, if not all of you,
are influenced by  higher motives;  that for you, the whole-
sale charge, so  often  made, is  false, "that  in America the
'Almighty Dollar'  is the  only deity  that is  sincerely wor-
shipped;"  that you have  embraced the medical profession as
one which will give  scope to the cultivation of the highest
intellectual faculties and to the  most enlarged benevolence,
and which may lead to an  enviable position in society, to be
attained by merit and by  merit alone.  If these be the sen-
timents which animate you, if you work and toil unceasingly
with  enlarged  minds and ardent  impulses after  the  true
and the good, not  turned  aside  by  the  lures and charms of
political ambition,  or  rapidly acquired  wealth, there  is hope
that you may attain all and more than  all that  you seek or
anticipate.
        "So live, that when the summons comes to join
        The innumerable caravan, that moves
        To that mysterious realm, where each shall lake
         His chambers in the silent halls of death,
         Thou go not like the quarry-siave at night.
         Scourged to his dungeon; but sustained and soothed
         By an unfaltering trust, approach thy grave
         Like one who wraps the drapery'of his'couch
         About him, and lies down to pleasant dreams."
      (                                  —Brycmfs Thmwloimi?