SECOND EDITION. AN INTRODUCTORY LECTURE, ON THE MEANS OF PROMOTING I THE INTELLECTUAL IMPROVEMENT OF THE STUDENTS AND PHYSICIANS, OF THE VALLEY OF THE MISSISSIPPI. DELIVERED IN THE MEDICAL INSTITUTE OF LOUISVILLE, November 4th, 1844. BY DANIEL DRAKE, M. D. PROFESSOR OF PATHOLOGY AND THE PRACTICE OF MEDICINE. PUBLISHED BY THE CLASS. LOUISVILLE, KY. PRENTICE AND WEISSINGER. 1844. "1* W 13 7611 NOTE. Had the Author anticipated, in a hasty composition of the following lecture, that those to whom it would be addressed, would ask for its publication, he might have written it in a less careless and declamatory style, and sought to throw into it some ideas not quite so commonplace, as those which make it up. His en- gagements do not permit him to re-write it, and he does not feel disposed to consult his reputation so far, as to withhold, from those who are desirous of carrying away, the plain spoken advice which it contains. It goes out, therefore, with all its literary imperfectiens, bearing the Author's hope, that, in despite of them, it may effect something, in quarters where reform is g»eatly needed. SECOND EDITION. A demand by members of the class for a greater number of copies than were printed, has led to this second edition. In submitting it to the press, the Author has introduced, at their appropriate places, three additional articles, on topics which he had inadvertently omitted, on the delivery of the Lecture. INTRODUCTORY LECTURE. Gentlemen: I presume you are aware, that by a late regulation of the Institute, we have but one public Introductory Lecture. Its delivery this year is confi- ded to me, not because I am regarded as peculiarly fitted for the task, but as the next in seniority, to the distinguished and venerable professor, who, as the organ of the Faculty, met the class of the last session, Youwill please, gentlemen, to make the distinction between a salutatory by the Faculty through one of its members, and the greeting of each pro- fessor for himself. In the latter case, it is his duty to introduce you to his special department, and raise in you an interest, without which your at- tendance on his lectures will be irksome and profitless. In the former, it is the duty of him who has the honor to speak for his brethren, to press on your attention, and, if possible, impress on your hearts, those principles and precepts, which are as necessary to the successful progress of an as- semblage of students, as are the laws and forces of the Universe, to the movements of a constellation of heavenly bodies. But you must not sup- pose, that I shall attempt to illustrate all the great principles of impulse and propriety, in which the student should be trained, for the limits of a lecture would not be sufficient. I shall, therefore, select such as seem to me, from experience and observation, to be of most practical utility. And among these, again, I shall almost limit myself to those, which relate to Intellectual Improvement. Some of them will apply only to your studies in the Institute, others to your whole professional lives; but they will concur in establishing the habits, without which professional excel- lence and fame will be found unattainable. My first proposition is, that you should labor to conform to all the rules laid down by the managers and professors of the Institute, for the govern- ment of those who constitute its classes. A want of such regulations in some of our schools, and a practical indifference towards them in others, may fairly be ranked among the drawbacks on the progress of the whole. This indifference, sometimes amounting to contempt, has its origin in four different sources. First: the short duration of our sessions, raising in the minds of students the feeling rather than the matured idea, that for so brief a period, the same organization and government are not necessary, as for a longer college residence. SecSnd: the almost total absence of discipline in the period of private pupilage; the preceptor seldom laying down any rules, and the student, for the most part, coming and going at 4 his pleasure, not even making his intended absence known to his preceptor: reading on one topic to-day, and, leaving it unfinished, taking up another to-morrow; defacing and displacing both volumes; surrounding himself acquaintances, and delivering himself over to light and excursive conversa- tion, in the midst of the gravest inquiries; neglecting to take the requisite exercise, and at the same time establishing no regular hours of study. When students with such habits, congregate in a school, they have of course little predisposition to coalesce into a class, under the regimen of wholesome and necessary laws. Third: the almost unlimited personal liberty guarantied by our political constitutions and laws; generating in young minds a high degree of freedom of thought and action, imparting to them ease and, indifference in the presence of persons venerable from age or science, and rendering them impatient under the restraints, which in many countries have been considered essential, to family and college disci- pline, contributes largely to prevent the students of our medical institu- tions, from submitting willingly and gracefully, to rules of order; which, nevertheless, are essential to the object for which they congregate. Fourth: another obstacle to the attainment of the same end, is the pres- ence of so many, who have passed the age of discipline, and of a number who are quite as old as some of their teachers, and have even been private teachers themselves, and who start at the proposition, that they must sub- mit themselves, as pupils, to the authority of an alma mater. Let me, however, say to one and all of you, gentlemen, that the fruits of a ready and persevering acquiesence, in a system of rules for the pres- ervation of order in the lecture rooms, the dissecting rooms and the hospi- tal, will be precious to every one of you. Just as precious as they are found to be, in the common school, the academy, or the literary college. I would especially say to those who have been engaged in the practice of medicine, the seniors of the class, that it is expected of them, to set an example to their younger and more volatile classmates, of that respectful observance of the laws of the Institute, which will secure the obedience of all; and thus maintain the state of repose and propriety, which will enable themselves, without interruption, to prosecute the studies which have attracted them within our walls. Should they fail in deference to the established rules of order, their juniors cannot be expected to comply; and thus there may grow up around them, a state of confusion utterly incom- patible with the end for which they left then- families and patients, and traveled hither from their distant homes. A second proposition, which I would submit to you, is, that you should forego the pleasures and amusements of the city. They stand in direct opposition to successful progress in the study of science. The loss of the time actually devoted to them, is the least of their sinister effects. They stir up the physical sensibilities, excite the imagination, and banish that 5 sobermindedness, which the search for facts, and the analysis of problems, absolutely demand. Thus the indulgencies of an hour will mar the acqui- sitions of days. The disorderly trains of thought and feeling, which they engender, may for a long time render the ear insensible to the voice of truth. Her most eloquent and impressive accents will fall unheeded upon it. The eye that is dancing with pleasure, or dull from its excess, sees but imperfectly the aspects of disease in the clinical wards, the most instruc- tive demonstrations of the amphitheatre, or the most brilliant experiments of the laboratory. The hand that has been rendered tremulous from ex- cess of nervous excitement, is poorly fitted to wield the dissecting-knife. The love of pleasure and the love of science may coexist, but cannot be indulged at the same time; though in fact they are seldom found united. A student should draw his pleasures from the discovery of truth, and find his amusements in the beauties and wonders of nature. He should seek for recreation, not debauchery. The former invigorates the mind, the latter enervates it. Study and recreation, properly alternated, bring out the glorious results of rich and powerful thought, original conception, and elevated design; dissipation wastes the whole, perverts the moral taste, and impoverishes the intellect. One makes great men—the other wild men. One creates the sun—the other the comet of the social and sci- entific heavens. A fixed luminary, spreading light and life on all around, is one—a wandering, flashing, and vanishing meteor, is the other. Would you shine on, with undimmed lustre, till a new generation shall bow in reverence before your mellow light, taste only of recreations: would you flare up for an hour, and then go out forever, prepare yourselves for the garish exhibition by feasts of pleasure. A third proposition, which I would maintain, is, that the time allotted for studies in our schools, is so short, that the utmost diligence is required. How often is a student ruined by the delusion, that having secured many teachers, he may relax in his exertions! I tell you, gentlemen, that thou- sands of young men have been blighted in the bud, by this sirocco of in- dolent minds. It is a commonplace remark, that the application of the students of America is small, compared with the industry of Em-ope: it is painful to add, that this mortifying contrast has not yet been sufficient to arouse our young men to greater effort. They are content to look up to those whom they ought to emulate. They are willing to feed on bread earned by foreign labor. Their want of industry makes them dependent. These remarks apply to the whole pupilage, often to the whole profes- sional lives, of too many of us. We enter on the study of medicine without earnestness, and prosecute it without energy. The first feeling of fatigue closes the book: The first yawn extinguishes the lamp of study. Admirable hygienic prudence! Gentlemen, I tell you in plain, straight- forward, homely phrase, that you must study hard, or you will run the 1 * 6 risk of disappointment, in aspiring to the honors of your alma mater. Her ambition is, to raise the standard of graduating attainment, higher and higher every year; she wishes her sons to walk forth into the world, on as high a level as any others. I beseech you, not to suffer the fruits of your indolence to put her to the blush. The ambition to rival your brethren of the old world, and the desire to do honor to your alma mater, should of themselves, stimulate you to industry; but there are still nobler motives under which you should prosecute your studies, both now and hereafter— here and elsewhere. It is your duty to leave your profession better than you found it, but if you while away your time in the Institute, how can you pay the debt you owe to those, who brought our science to the state in which you find it? Again, the lives of your friends and fellow-citizens are to be confided to your care, and how can you make yourselves worthy of the sacred trust, if you suffer the opportunities within your reach to pass unimproved? It is in the Institute, that such of you as may be con- stitutionally indolent, or, from bad example, have fallen into the habits of idleness, can best correct them; for the circumstances of your new situa- tion, are well fitted to stimulate hebetude into activity, and apathy into earnestness. The case of a student who comes to the school with idle habits, is not hopeless; but he who goes from it without their being cor- rected, is incurable, and should be banished from the ranks of our noble profession. No period of study however protracted, no estate, however opulent, no family connexions, however influential, no genius, however brilliant and pervasive—nay, even the whole, in one illustrious union, can set aside the simple law of human nature, that intellectual riches, can only he acquired by unwearied industiy. A fourth proposition which I lay down, is, that you must proceed from the known to the unknown. But few of you have done this, under the r guidance of your private preceptors; and I am sorry to be obliged to con- fess, that our schools are not so organized, as to correct the evil. While certain branches cannot be understood without a previous acquaintance with others, the whole are taught at the same time. Whether our uni- versities will ever be so reorganized, as to improve their present imperfect methods, cannot be foreseen; but this is certain, that you must complete your studies on the present plan. You must take our schools as they are, and make yourselves sound and scientific physicians and surgeons, in de- spite of their defects. You must, in your first course, devote yourselves with the greatest intensity, to the branches which are introductory to others—first, the rudimental, second, the practical. If you do not understand chemistry, and to a limited extent, natural philosophy, how can you comprehend certain functions of the body? How can you know the reciprocal reactions of your medicines, and the relations of poisons and antidotes.' How can you prosecute several important 7 aetiological inquiries? If ignorant of descriptive anatomy, how can you, understanding^, follow the knife of the professor of surgery? If unac- quainted with the tissues, and the composition and relations of the organs, how can you know their functions? how embrace the beautiful generaliza- tions of physiology? how compare the healthy with the morbid structures? how enrich your minds with the principles and precepts of modern diag- nosis? Should you proceed to the study of pathology, without a previous knowledge of physiology, how hopeless the task! It has been well said, that disease is morbid physiology. It is, in fact, a mode of action incom- patible with the end, for which an organ was created. Can any thing, then, be more self-evident, than that pathology has such dependencies on physiology, that it must forever remain a sealed book to him who is ignor- ant of the latter? ■ When the violations of a statute can be understood by a judge, who is unacquainted with its provisions; or a departure from a given curve in mathematics appreciated by him who knows not its proper- ties, then, and not till then, can the student who knows not physiology, make himself a pathologist. How can the curative effects of medicine be studied, by him who is ignorant of their modus operandi on the body in health? Medicines cannot even be classed, much less prescribed, under- standingly, without such preliminary knowledge; to the acquisition of which chemistry, pharmacy, and physiology, are indispensable prerequi- sites. Lastly, how is it possible to study the practice of medicine, except in downright empyricism, if deficient, in any of the branches I have enu- merated, save operative surgery and surgical anatomy? It is the violation of this great truth, that has alloyed our profession with most of the quackery which disgraces it. I do not refer to the unblushing charlatanerie of the newspapers, to steaming, homoeopathy, root-doctors, and therapeu- tic mesmerism; but to nosology without diagnosis, and prescriptions without indications. I call upon you, gentlemen, hereafter to avoid this inversion in the order of study. I recur to the proposition, that you must pass to the unknown through the known. If you cannot follow those, to whom practical departments are confided, in their elaborate analyses, the fault is not theirs, but yours; unless you come up to the study with the full preparation I have indicated. They could not expound, had they not passed through the course of study on which I have insisted, and of course you cannot comprehend, without the same qualification. In this matter, nature is no respecter of persons. She will not let herself down to the level of ignorance or mental weakness—will not dissolve into her elements, to accommodate those who cannot analyze—will not approach, that she may stand within the focal distance of the intellectually near-sighted. Let me then entreat those who are but little advanced in their studies, to be- stow their first thoughts on what, in the order of nature, must be first studied; reserving an earnest attention to the more difficult branches for a subsequent course. 8 \ Fifth. You should make a right use of your text-books. I have some- / times thought it would be well, if all text-books were banished from our schools. The idea present in the mind of a student, that he may by reading when he goes to his room, make up for inattention to the leetures, is productive of inattention. Still further, when he reads he very often does it, not to bring the lecturer to the standard of the author, but to learn from the latter, what he neglected to learn from the former. My opinion is, that the best mode of study would be by text-books, with ex- aminations upon them and illustrations of them, by the professor; but such is not the fashion of the world. You are to be taught by lectures, rendered intelligible by experiments and demonstrations. It is your duty, then, to apply yourselves to what you hear and see in our halls; not to the books with which you may load your tables. You must not only hear and see, but remember. A defective scientifiic memory is almost universal in the country to which you belong. It is the natural consequence of imper- fect exercise in early life. Memory, like attention, comparison, or any other operation of the mind, is strengthened by exercise. Resolve, then, that you will strengthen your memories by exerting them on the lectures. Make it the work of every evening to travel over the lectures of the day, and recollect and write down, at least, a synopsis of the whole. Thus and thus only, will you make them your own—receive an equivalent for your time and money. When you have reproduced a lecture in your mind, then, and not before, proceed to compare it with what your author has said on the same subject. This is what I mean by making a right use of text-books. Employed in any other way, they do harm instead of good. Sirth. You should remain to the end of the session. It is I think uni- versally admitted, that our sessions are too short. Every observing profes- sor, and every inquisitive or aspiring student, feel this great truth; and every physician, who loves his profession, should labor to correct the error and extend the term. Meanwhile it would be a great step for all our schools to require pupils, not only to enroll themselves before the delivery of the first lecture, but to remain till after the delivery of the last. The absence of such a law, is a great absurdity—a practical abandonment of the princi- ple involved in the rule, that two full courses are necessary to graduation. Why require two courses? Is not this demand an evidence, that we do not rely on mere examination into the qualifications of a candidate? Does it not say, that those who grant the degree must be assured, that the op- portunities of the student have been adequate? If so, why not compel his attention to them? Why not require him to be present throughout the whole period declared to be necessary? Why allow him to enter a month after the course begins? Why allow him, at his own discretion, to absent himself for weeks, in the course of the session? Why permit him, after taking the tickets of the first session, to return home the very next day if he choose? or at the holidays? or before the middle of Febru- 9 ary? after which, but few besides the candidates remain. I argue this point, gentlemen, to secure your influence in favor of a reform; in which the interests and character of our beloved profession are so deeply involved. You can talk it over among yourselves; you can speak to students whom you may see elsewhere; you can press it on the attention of your private preceptors, and thus contribute to the formation of a salutary public opin- ion. Above all, you can stay out the full term, on which you are now entering, and thus set a noble example, while you secure to yourselves the inestimable advantages of ample preparation. Seventh. You should attend three courses of lectures before you at- tempt to graduate. In this opinion, I believe my respected colleagues all concur. For myself, I regard it as most unfortunate, that all our schools ' had not been organized on the principle of three courses for graduation, two only being paid for. Such as should not choose to incur the expense of mere travel, boarding, and lodging, for the sake of graduating, after a third, could go into practice at the end of the second course; as the majority now do, in a most immature and unqualified state, at the end of the first. It is a most vicious public opinion, that frightens students into candidates, in the midst of then- career of elementary study. They are afraid to hold back, when they have become technically eligible, lest it should be said they are not intellectually qualified. Under this contemptible cowardice, we see students who are yet young, and whose means are ample, pressing forward and subjecting themselves to the risk of being rejected! To avoid an im- aginary, they plunge themselves into real danger! Who is the physician that ought to be respected—that is most likely to receive the confidence of society—is best qualified by his triumphs to maintain that confidence, and is most amply prepared to make discoveries and improvements? He who graduates in the shortest possible time, or he who makes the most patient and persevering efforts to become eminently qualified? Such questions suggest their own answers. Let me then entreat you, gentlemen, to pon- der deeply on this subject, and resolve that you will rise fi-om the path of mediocrity ta that of eminence. Eighth. I must give such of you as may not be candidates at the end of this session, a word of advice relative to your inaugural theses. By all means prepare them during vacation, for the labor of doing it in the session will divert your attention, and even detain you from many lectures. And while it produces these sinister effects, you will not be able to make your theses what they should be—specimens of experimental inquiry, or deep and logical thinking on existing facts—set forth in a pure and simple style. If you prepare them in vacation, you will have time for original observation and experiment, for reading, for natural arrangement, for conciseness and perspicuity of style. The time once was, when every candidate had to write and print his thesis in the Latin language; then came writing and 10 printing in his vernacular tongue; lastly, writing with the option to print or not. I have always regarded the last relaxation of rule, as injurious, from its abolishing a motive to application. Let anyone look into the collection of Theses, published in the early part of this century, by a learned profes- sor of this school, and he will be convinced, that when students were re- quired to print their theses, they applied themselves with greater and more successful diligence. Since candidates are no longer compelled to publish, they regard the composition of their theses as lost labor. But have they no desire for the approbation of their teachers? No regard to what their successors—near and remote—may say of these productions, when they look over the ponderous manuscript quartos, which are beginning to en- cumber our shelves? The truth is, that while all graduates ought to feel anxious and ambitious about their maiden productions, most of them pre- sent such, as are any thing else than creditable—such as should make them ashamed. There are three classes of subjects from which candidates might advantageously select. First. The physiological and therapeutic effects—the modus operandi and curative powers—of the new medicines which chemistry is pouring into our magazines. Second. The endem c diseases of our country. Third. Our native medicinal plants—the phar- maceutic and clinical history of which, is so strangely neglected. The candidate for graduation should choose from among these, and make his diesis a positive contribution to the science. In doing so, he would give himself an impulse on the path of improvement, which might continue throughout his whole life; while his teachers would have it in their power, greatly to his advantage, to speak of him as a young man who had already given an earnest of future distinction. Ninth, and lastly, I would advise you to suspend your studies on the Sabbath day. In thus counselling you, I pass by the high moral and Christian considerations, which might be offered, and rest the advice on your intellectual improvement. This, I am persuaded, Avill be greater and healthier, if you rest from your studies on that day; and afford your men- tal faculties repose. In ordinary reading, the book is laid down and re- sumed, according to the presence or absence of mental fatigue; but in a session of lectures, where seven teachers keep you six hours a day under the spur of their eloquence, you cannot hold up, and a day of rest becomes indispensable. Even the furnace of the founder requires cooling; but the young mind needs it much more. When you fold up your note-books on Saturday night, close the gates of memory, that nothing may straggle out; and let your imagination, understanding, and feelings, refresh themselves by idleness, or occupation on other topics, till Monday morning. Thus, will you enter our halls reinvigorated, and aptly prepared for the labors of the week before you. 11 Gentlemen! Should you prosecute your studies in the manner I have pointed out, most of you will enter on the practice of the profession with adequate preparation. I cannot, however, indulge the expectation, that such will be the case with the majority. True, I hope that all will be industrious and orderly, and almost hope, that all will continue their pupil- age to the end of the term; but most of you will never return to this or any other institution. I may, therefore, extend my remarks to the profes- sion, of which you are shortly to become members, and discuss some of the great principles on which you should then act for the attainment of intellectual distinction. In the first place, let me apprise you, that on leaving the Institute to practise medicine, whether as graduates or not, you will enter a profession, the majority of whose members are inadequately educated, both in litera- ture and science. It is your duty, as it should be your ambition, not to swell this catalogue, already so numerous. You must not compare your- selves with the poor in professional spirit and attainments, and being con- tent to equal them, fall into the throng of mere sciolists. Remember that you will go forth as juniors in the midst of seniors, and that in forming your professional character, you will instinctively imitate those around you. Unfortunately this instinct does not always direct us to the proper models. Many young physicians have been ruined in their intellectual develope- ment, by adopting low and imperfect examples. If you would improve your literature, and expand and purify your science, compare yourselves with the learned and logical—with those who are ambitious to write their recipies in plain and accurate English or in correct Latin, instead of a grotesque mixture of the two, each being incorrect; with those who attend to the rules of grammar in the directions they write for their patients, and do not begin by addressing them, and end by speaking of them, as though there was no foundation in nature for the persons and cases of pronouns; with those who can write letters without violating the first laws of orthog- raphy and syntax, and report cases without mistaking the technical terms of the science; who can spell stomach without a u, and bilious with a single 1; who can stop when they are done, and be done when they stop! If you do not open your eyes to the lethargy into which so many of our brethren have sunk; if you do not cherish a livelier and purer taste for ac- curate learning than theirs; if you do not feel ashamed of gross illiteracy, superficial science, intellectual indolence, and contented mediocrity, you are ruined. I beseech you, gentlemen, to form the resolution—now, at this moment—that you will not add to the number of those who drag down our beloved profession, but of those who are toiling to raise it into the pure, upper regions of truth and beauty. Second. When you may open offices, do not practise imitation, but guide yourselves by first principles. If it be difficult to find good models 12 of study, it will still be more difficult, to find an office so arranged and kept, that the aptest mind could study in it. I say, then, appeal to principle, and begin a new series. You may smile at the importance I am attaching, to what you will regard as a small affair, but time will rectify your esti- mate of things. My firm opinion is, that one of the causes which retard us, in raising our profession in the A\rest and South, to an excellence which at present seems almost hopeless, is the style in which our offices are fitted up and kept. Who can read and think, with method or sound logic, while every thing around him is dirty and disordered? His little stock of furni- ture displaced, as if a riot had just passed away; his books scattered on chairs, tables, and the greasy medicine-shelves; in his book-cases, volumes of different sets mixed together, some lying flat, and some, like the ideas of their reader, upside down; his skeleton exposed, and joint after joint torn off; his few injected preparations, unvarnished as my narrative, and worm- eaten, as the books of an old doctor; his medicines unlabelled, and thrown into a chaos, as great as a treatise on the Materia Medica in the fourteenth century; bundles untied and bottles left uncorked, or stopped with plugs of paper; dead flies in the ointment within his jars, while others are wading through that which has lain so long spread over his counter, that their feet are blistered by its rancidity; his spatulas, foul and rusty; his scales tied with strings and balanced with pieces of paper; his mortar, about as clean as the ancient Kentucky hommony-block, which, in the same day, contained the food of the family, and the family cow and horse, as it stood convenient to all the parties, on neutral ground, near the door of the cabin; his surgical instruments oxidating and rusting away, like his mind; his study-table, covered with loose papers and medical journals (even the Western) with their covers torn off; his walls overspread with a tapestry of cobwebs; his windows as opaque from dust as the painted glass of an ancient cathedral; his foul candlestick standing all day on his lexicon, and his floor spotted over with the blood of his surgical patients, and his own tobacco-juice! The human intellect cannot act when thus encompassed. Ideas will not arrange themselves; nor will their foul surfaces cohere. The scene reacts upon his mind, and a chaos within rivals that without. Other disadvantages still result from this official derangement. 1st. When he who vegetates in its midst wants a book, a medicine, or an instru- ment in haste, it cannot be found. 2d. In compounding medicines he is apt to make mistakes, and all he puts up is filthy. 3d. It is attended with great waste, an effect which few young physicians are able to stand. He who should cause every physician in the Valley of the Mississippi to keep his office in order and neatness, would give a greater impulse to effi- cient study, than the eloquence of all its professors, and secure to himself the name and fame of a public benefactor. 13 In the third place: You will mingle with colleagues, whose habits of observation are extremely imperfect. Medicine is not a science of medita- tion but observation. Hippocrates was an observer—Sydenham was an observer—Hunter was an observer—Rush was an observer. But you will ask, are not all men observers? I answer yes, but what observers the ma- jority are! Children, mere children, and not children either; for they lose the activity of observation which belongs to childhood, while they retain its changefulness—its superficiality—its thoughtlessness. The faculty of ob- servation requires a training which it seldom receives—the function of observation, an amount of accurate preliminary knowledge which very few acquire. The diagnosis of every case of disease, is to be made out by observation: the effects of medicines are matters of observation: the post mortem appearances in every dissection are subjects of observation. In the whole, inaccurate observations lead to erroneous conclusions. Without previous elementary knowledge, we know not what things should be looked for, and this is a great source of defective observation; but with ample pre- paration, our observations may be vitiated: 1st. By mistakes resulting from carelessness; 2d, by omissions. In the former case, we report and diffuse positive, in the latter, negative error. Half the reported cases which make up our clinical archives, are imperfect from one or both of these causes. To this criticism, we of the Valley of the Mississippi, are as obnoxious as any other physicians of the age. Who among us has not found, when a physician has been called to consult with him. or he has been summoned to consult with another, that to make out a satisfactory history of the case has been extremely difficult? Who does not know, that, in this extremity, the imagination often supplies, from analogy, what should have been collected by observation? Who, in reading reported cases, does not find that facts are absent, which more activity and fulness of observation would have introduced? Many a- clinical history, on the composition of which its author had expended much labor, has utterly failed to enrich or advance our science, because of his vague and inaccurate observation. Correct obser- vation implies not only intelligence, but sustained attention. Look to the pilot of the steamer which brought you hither, for an illustration. He knows what should be avoided, and where flow the deep waters through which he may steer in safety. This is his knowledge—the rest is observa- tion; in the performance of which, constancy of attention is all that he exhibits. The moment he fails in this, you are liable to be wrecked. This attention, without which there can be no efficient observation, is equally indispensable to sound memory. Why do we recollect the symptoms of an uncommon disease for years, wdiile those of common cases fade away in as many weeks, but because the new or eccentric character of the former, awakens and sustains our attention? The mind opens its bosom and re- ceives the impression on its heart, rendered soft and susceptible by the 2 16 Indeed, seek to find your pleasures in your books, and not in the gossip of the world around you. Raise yourselves above it—that you may secure its admiration. Seventh. Do not shape your course, by the example of those with whom you will associate, in regard to publishing. Of the thousands who practice the profession in our great valley, how few contribute by their pens to the magazines of knowledge! An immense majority leave no manuscripts behind them but their ledgers and recipes. In vain have the most precious original phenomena passed in review before them, never perhaps to be repeated before any other observer. In vain have the ar- rangements of Providence favored them with an opportunity of consigning their names to immortality. In vain has the periodical press invited their contributions. With stolid insensibility they neglect the whole, and die without leaving their profession richer than they found it. The last mantling on their cheeks should be a blush of shame for such criminal neglect. But do not conclude that I recommend extended publications, or an indiscriminate putting forth of all that may fall under your observa- tion. No, indeed, far, very far and foreign from what is in my mind, would be such advice. Publish that which ought to be published, and nothing else. But, you will ask, who shall decide? I answer you yourselves. Study your profession as you ought: read, to know what has been already published: think, to be assured of the bearing and value of what lies before you; and you will seldom offer that which your brethren will not grate- fully receive. Eighth. Resist the Western propensity for change of residence. Turn from the example of those physicians, who seek in new localities the practice and prosperity which must flow from industry, patience, and per- severance. The endless shifting of place which our Western and South- ern profession displays, does not diminish their number, nor abate the competition; but it keeps, at all times, a multitude out of employment, and has destroyed the prospects of more than it ever built up. Select with care—then persevere with deathless constancy. Let me draw an exam- ple from the mines of Wisconsin. The mineral district, as they call it, presents two classes of miners: first, those who dig superficially, and find- ing no treasures, abandon spot after spot for some other, which their fancy suggests will be more productive; second, those who dig deeply, and perseveringly follow up the same metallic vein, till they enter its rich cav- erns. Make these your model, and you will sooner or later enjoy their reward. Ninth. Avoid the example of those who are ever ready to relinquish their profession for some other. In giving you this advice, I am apparently counteracting the interests of those whom 1 represent; for the practice I am reprehending increases the number of students. Nevertheless, my colleagues look to the dignity of the profession, not less than the emolu- 17 ments of teaching. He who is willing to abandon his vocation, generally looks out for the opportunity, and, as a matter of course, ceases to cultivate it. When a very young man leaves the ranks, it is a small affair; but when a physician of ripened experience goes out, society suffers. A raw recruit may desert when the battle is impending, without causing defeat; but a veteran cannot be spared. The practice of which I speak, prevails in some parts of our country to such a degree, that the care of society is al- ways in the hands of the inexperienced. There is little of the knowledge which comes from long and varied practice—the sound judgment which time only can confer—the sympathy which flows from the cherished inter- course of years, between physician and patient. An epidemic sweeps over the land—there is no veteran arm to save—no friendly eye to pity. I be- seech you, gentlemen, after having, through days and nights of toil, acquired your profession, not to cast it off. Regard it as you would a wife whom, through storm and sunshine, you had won by vows and prayers and pledges. Make it your bride and value her for the price you have paid. Adhere to her for the sake of her honor. Let not merchandise, nor tavern-keeping, nor office-hunting, divide your affections with her. Let not the sugar-cane boast of a conquest over her; nor the cotton-plant triumph at her desertion; see that she does not perish by the hemp! Confide in her, and she will prove faithful to you; labor in her service, and she will amply repay you, with patients when you are in health—with sympathising friends in your sickness and sorrow. Such a bride, never waxes either old or ugly; for every year brings out some new aspect of beauty—some brighter tint of loveliness. She will enrich you with the means of independence—'She will do you good and not evil all the days of your life;' and when you are no more, she will erect to your memory an imperishable monument. Tenth. When you join the profession, you will become teachers, and a responsibility of a new and serious kind will devolve upon you. Do not prepare to meet it, by copying after those with whom you will associate. Do not encourage young men, who are unqualified by infirm health, or mental weakness, or want of means adequate to a proper continuance of their pupilage, to engage in the study. Suffer not your own interests to conflict with those of society; nor your thirst for the distinction of having a pupil, to render you insensible to the dignity of your profession. We want more talent and learning, more ambition, more love of knowledge, more of burning zeal in our profession; and it is only to private preceptors that we can look for their introduction. Of yourselves, I know nothing, and hope there may be none among you, whom nature has better fitted for some humbler calling. But this hope is not founded on experience; which testifies that in all the schools of the Union, there have been many whom no exhortation could arouse, no tuition instruct; whose dulness, fickleness, or indolence barred them from every other calling, and caused them to drift 2 * 18 upon ours, in which it was assumed those defects would be no disgrace. It is time that the watchmen on the walls of our professional zion, sounded an alarm. Our gates should, henceforth and forever, be closed against those who cannot be made men of science. But your duty as private pre- ceptors, is not comprehended in this exclusion of the unqualified and un- worthy—you must teach as well as select. Your pupil should never be out of your grasp—never permitted to wander from the path of study which you mark out—never be allowed to loitre upon it without reproof. Whatever may be the defects of the best schools of the Union, however disqualified their professors, justice to both requires me to declare, that the delinquencies of private preceptors are far greater; and constitute the first, the most prolific cause of imperfections, which all who love and respect the profession unite in deploring. It will be for you, gentlemen, to arrest the degradation which this negligence has generated. You should do as you would be done by, not as too many of you, I fear, have been done by. i'ou should spur up the indolent—cheer on the faint-hearted—clear away the doubts of the perplexed. You should travel over every book which your student reads, and by a few searching questions, on its governing proposi- tions, ascertain that he has mastered it. But you must impart as well as extract; and illustrate every topic from your own resources, as well as inter- rogate. Thus, while you do your duty to him and the profession, you will not only preserve your own science, but enlarge it under the creative action of your own faculties. So true is it, of every relation in life, that a consci- entious discharge of duty benefits ourselves not less than others. Gentlemen! Although my object is to facilitate your mental improve- ment, I feel unwilling to close, without pointing to a field, where you may find ornaments for the well developed and manly intellectual character, to which you all aspire. I do not, now, speak of the field of religion, where you may pluck an immortal amaranth—the flower which never withers; nor to the field of morality, where the sturdy oak of virtue, calmly defies the foul winds of vice and temptation; but to the field of manners, with its radiant flowers, its rich odours, its graceful wreaths, its bowers of en- chantment. Here grow decorations for every variety of character, for men of all pursuits, for every position in society, for all the untold and un- expected emergencies of social life. And so flexile—so appliable too! You may bind them around the imperishable amaranth—you may hang them on the limbs of the symbol of virtue, which they will continue to embellish, after its trunk has decayed, and it no longer puts forth leaves and fruit. The graces which can, thus, render piety more lovely, and can even throw a reconciling drapery over perishing truth, honesty, tem- perance-, industry, and honor, must have a charm for mankind; and should be sought out by every young man, while he is gathering up the materials for a solid monument of fame. I am sorry to know that this is not done, 19 Not done, even by those who labor with but little diligence, on the homely structure of a common-place reputation—that which most of all needs ample decoration. The truth is, young gentlemen, that we belong to an age and nation, in which refinement of manners is not particularly cultivated; and our delin- quencies are so prevalent that we keep each other in countenance. Our national character—its Backwoods' portion at least—has in this respect a downward tendency; and if we do not glory in our shame, we glory in its causes. Our rudenesses spring from our republicanism—our passion for unrestrained freedom—our love of personal independence. Under politi- cal institutions, where polish and delicacy of manners are the necessary checks of unbounded liberty of individual action, they are held in most sub- ordinate estimation. By a false association of ideas, we regard etiquette and ceremony, as incompatible with democratic government. Discarding privileged orders, we forget, that exemplary piety and high moral worth, genius, literary eminence, scientific distinction, and matronly dignity, are natural objects of respect. Our chivalry is rude, and we take more pride in fighting than bowing. Emigrants from older communities think, that in coming among us,.they may leave behind some of the conventional usages to which they had conformed; and instead of appearing as missionaries of social refinement, they swell the number of those who regard the cultiva- tion of manners as unworthy of attention. Make a voyage upon one of our steam packets, and listen to the up- roar of the card table, where gentlemen detached from respectable families, in the midst of the aged and reverend, emulate the mingled sounds of all the machinery; watch the dinner table, and see the flaxen-haired youth anticipate the hoary headed sire in the choice of a seat; walk on the guards, where gentlemen's legs continue to rest upon the railings, till you push them off. Seat yourself at the table of a hotel: before you have begun to eat, he on your left will thrust his arm across your breast, that he may abduct some savouiy plate; you cease for a moment to guard your own, and see a portion of its contents adhering to the coat-sleeve of him who is on your right. Walk our streets, and look at the volumes of tobacco smoke, which, like those of a steamer, indicate that a gentleman is about to turn the corner. You meet him. Does he condescend to raise his hat? He does not even think of it. Do you stop to converse with him? He 'keeps up the steam,' and the smoke of his furnace polluted by his breath, draws tears from your eyes, without his intending or giving offence. You call on a gentleman, but do not expect him to return it. He goes on the credit system, acknowledges your claim, but declines paying, till he has more time on his hands than he can otherwise appropriate. Visit a lec- ture room, and what do you see? A salivary infusion of tobacco, drivelling from the corners of a student's mouth, on the skirts of the gentleman be- fore him; while his own is receiving an impress from the dirty boots of the 20 gentleman behind him, as they quietly rest on the back of the seat. Hap- pen into one of our drawing-rooms, the citadels of taste and good-breeding, and look at the young gentleman with his legs reposing on a chair, and his hat as firmly fixed on his head as if it were a natural integument; turn to the young lady, self-complacently seated in the old arm-chair, surrounded by aged persons, talking and rocking till her lips and feet tire out. Attend a great fashionable party. Some timid young lady is persuaded to seat herself at the piano; the sound of the key note is the signal for louder talking; her performance advances, but its melody is lost amid the din of a hundred voices. Supper is announced: let matrons and mothers stand aside for the nimble-footed young couple, who go ahead; look at the throng of ladies, driven through the doors and defiles of the mansion, by a crowd of gentlemen behind—prepare for torn dresses and bruised elbows. You are called to visit the sick, and dash into the chamber as if it were your own dormitory; you speak to the attendants as if they were the servants of your own house. A physician comes to reside in your neighborhood. You make him no call of ceremony, but stand aloof, till he thinks you hostile, when you are not; and he becomes an enemy, because you had neg- lected the duty of a gentleman. Such are a few of the counts in my in- dictment against the society, in which you are to go forth as members of a learned and liberal profession. I need not consume your time with the examination of witnesses, for, unfortunately, we are all familiar with the facts. I exhort you to avoid the whole. Every physician should be a gen- tleman, and show it in some more unequivocal way than shooting the man who may doubt it. He should be a gentleman in manners as well as prin- ciple. The fruit of his principles, should, indeed, be urbanity and refine- ment. He should, moreover, be a gentleman in dress as well as address. Slovenliness is as bad as torn and Blotted directions for a patient—dirty clothes are as disgusting as foul pill boxes. They are all unprofessional —all in bad taste—all repulsive to the sick. In this country, medical men exert more influence on the manners of society, than any other class, except the rich. They are watched and imitated. This is a great tribute to the profession, for it shows the instinctive respect and admiration of the people. Let us make it, in fact, what that instinct implies, a community of gentlemen—giving lo that cherished appellation the broadest definition. Finally, if all physicians were to become gentlemen in deportment, as well as principle, half their quarrels would be averted. We are forever harp- ing on medical ethics, but the number of special observances required in our intercourse is very small. Let us study and practise the rules of a rational politeness, and all things necessary to a delightful harmony, both personal and professional, will be added thereunto. Gentlemen! What I have spoken on the necessity and means of in- tellectual improvement is of general application. In conclusion, I must 21 say something, in which a part only will find themselves interested. A portion of you are the' sons of men of wealth, and may, without incon- venience, defer the time of entering upon your professional duties. To this delay there can be no objection, but the reverse, provided you occupy yourselves on the means of increasing, diversifying, and embellishing your scientific knowledge. Apart from mere reading, there are three modes, any one, two, or all of which, you may pursue. I propose briefly to state and illustrate the whole. First. You may visit other schools, in your own country, and attend the lectures on practical branches, or indeed on all. Thus your knowl- edge will be confirmed to you, without the irksomeness of listening too often to the same professors. Some of your new teachers may, at times, go more extensively into certain subjects than you had been inducted be- fore. Others, in coming over debatable ground, will excite your curiosi- ty, stir up your feelings, and give activity to your thinking. At the same time, you can visit different hospitals, and witness various modes of prac- tice. You will also be able to examine cabinets of mineralogy, zoology, and comparative anatomy; listen to lectures on those subjects, and attend the sittings of learned societies; finally, you can mingle with general society, and thus improve your manners, while you increase your knowledge of the world. ' Second. Some of you may be desirous and able to visit the Universities ) of Europe. So far from discouraging, I would encourage this disposition. But let me warn you, gentlemen, not to substitute foreign schools for those \ of your own country. When you have exhausted the means of instruc- tion afforded by the latter, then, if convenient, resort to the former. It is mortifying to see our unfledged young men, with diplomas to which they often have perhaps but an equivocal claim, depart for foreign lands, profoundly ignorant of their own, and unacquainted with most of what is taught in its schools. Why should a young man thus bring odium on his native land, and contempt upon himself? Why go abroad to acquire, what he can better learn at home, the rudiments of the profession—the first lessons of science? And that, too, without knowing the tongues spoken by his new teachers! Will change of place confer language, or change of teachers give understanding? To gain knowledge, a man must observe; to get understanding, he must think. Let not those who have never observed nor thought on the banks of the Ohio, assume that they will do either on the banks of the Seine or the Rhine.or the Thames. The chances in fact are quite against it; inasmuch as the novelty and allurements of their new situation, are likely to divert them from its advantages. There is an- other obstacle to the improvement of our novices in Europe. They so- journ there, under the natural feeling that opportunity may supply the place of application; and that the reputation of having studied diseases abroad, can be substituted for a knowledge of their proper treatment at 22 home; both of which will abate their industry, and reconcile conscience to the neglect of opportunity. To reap benefit from foreign study, three things are indispensable—first, that the student should have mastered the elements of his profession in the colleges of his own land—second, that he should understand the languages to which he is to listen—third, that he should protract his stay far beyond the time usually allotted. Under these conditions, any one, or all of you, might visit Europe with advantage— in their absence, you had better stay at home. Lastly. I wish to recommend to those who have ample time and means, a third source of improvement after their graduation. I mean researches into the physical condition, manners, customs, physiology, and diseases of their native land—this great and glorious valley of ours, the Eden of the New World, from which I trust our crimes and follies may never drive us out. Who has opened his eyes, and looked inquisitively and yearningly on this vast book of nature, here and there embossed with art? Who has studied even its table of contents? Who has made an index to its countless beauties? Who has yet realized that it might be to all its physicians a book of wisdom? Alas, nobody! Young Gentlemen, I invite such of you as are not under the necessi- ty of going into practice, when you leave our alma mater, to turn your eyes to this mighty field. Do you not wish to know its structure, produc- tions, and climates; and could you better study geology', natural history, and meteorology, than by connecting those sciences with all that is dear to your childhood—with the cherished associations of school-boy days? Do you not wish to study the varieties of the human race, that your knowl- edge of physiology may be enlarged? Why not compare, then, the three which surround you? Do you thirst after an acquaintance with the influ- ence of manners and customs and vocations on human health? Why not dwell on those which are at hand? Would you know the diseases of va- rious latitudes and localities? Why not traverse and examine those which spread out from you on every side? Would you extend your acquaintance with the members of the profession to which you aspire? Why not visit and sojourn among them; learn the secret of their success or failure; acquire the results of their experience; and establish with them that scientific cor- respondence, which they have not yet begun among themselves, but which made general would at once enlighten and exalt our young profession? I am deep in the conviction, that a couple of years spent in this way, by a tho- roughly educated young physician, would do more to develop his character, and fit him for every day usefulness, than even the boasted European voyage. But he may, if he will, avail himself of both; in doing which, I would earnestly advise him not to go abroad, till he can no longer find ob- jects of appropriate scientific interest at home. Let him carry out an am- ple stock of knowledge on the physical condition and diseases of the new world, and he will find easy access to the men and magazines of the old. 23 Young Gentlemen: Let me repeat to you, let me say to the young persons of both sexes who have honored us with their presence this even- ing, that travels in our country might be made to yield an abundant harvest of pleasure, patriotic emotion, and general improvement, yet how few ap- preciate and use these precious opportunities! We are a migrating but not a traveling people. We think of our country only as abounding in res- idences; and pass from one to another, without inspecting anything be- tween them. Thus, even migration bestows on us none of the benefits of travel. In our transits, all things are sacrificed to speed. We are not satisfied unless we add night to day; and when we awake in the morning, congratulate ourselves that we are a hundred miles nearer the point of at- traction; although we may have passed through scenes and objects the most interesting, without beholding the least or the greatest of them. Thus while we are wanderers, we remain ignorant of the relations and true character of all among which we roam; or know them only in con- nection with hemp or cotton planting, commerce, land speculation, or the practice of law and medicine. How few have yet realized from personal observation, the limits of this Valley of a thousand streams—more comprehensive than Great Britain, France, Germany, Spain, and Italy—countries which have been the chief theatres of civilized society since the dark ages passed away. Who has ascended its gentle elevations, rising one above another, to the region of perpetual snow; or felt its climates, from the tropical heats of southern Florida, where the orange blossom perfumes the air, and the live-oak stretches wide its gnarled limbs, to the icy fountains of the Upper Missis- sippi? How many of the sons and daughters of this fair and favored land, have stood on its terraces and looked over its undulating prairies, where the grass waves and the flowers smile from the close of one winter to the beginning of another? Who has admired the tangled copses of flowering shrubs in the South, the lofty forests of the Middle, the open woods of the North, or the boundless savannahs of the unpeopled West, where in au- tumn a running fire lights up the darkness of the night? Few, indeed, have had their hearts thus kindled. Quite as little do we regard the rolling waves of green water, which, age after age, have mingled their wild voices with the murmuring breeze or the boisterous tempest—amid the green islands of Michigan, or on the white sands of the Gulf. Nor do we float on our mighty rivers and their countless tributaries, with their graceful curves, their shady banks of summer green, their autumn robes of 'mourn- ing gold;' their cane-brakes and their towering cliffs, with the admiration which ought to fill our hearts. Still less do we ponder on the rocks beneath— the tertiary forni.:rions of the South, more extensive than those of any other country—our ample limestone regions, so rich in organic remains—our drifted rocks and diluvial beds, abounding in fossil bones—our coal fields, the most extensive in the world—our transition rocks—our hills of iron. 24 and veins of lead and copper—our hot and mineral springs, chalybeate, saline, and sulphurous! But, not to dwell on the inanimate world, who bestows adequate attention on the life, the living and social movement of which he is a part? Who for himself, compares the African with the North American—the black man with the red—in their propensities, physiology, and diseases? Who studies them in connextion with the Cau- casian, whose subvarieties, from the valleys of Spain to the mountains of Norway, bring hither and commingle their peculiarities of physiology, modes of living, and exercises of ingenuity? Who contemplates with a fixed and discriminating eye, the new social combinations which are starting into existence on the banks of every little river? Who gives scope to his imagination and prophecies of the future? And yet, is there not improvement in the study of nature as well as of art? Is it not as salu- tary to the mind to witness growth as decay? Is it not more delightful to roam among the germs of a budding empire, than to clamber over the crum- bling monuments of those which are passing away? Is not the rising more glorious than the setting sun? Does it not speak to the heart of day in. stead of night—of life instead of death? Let us, in idea, connect the present with the future not the past, and resolve to make that future illus- trious. Let us cherish all that is American, and love our native West the dearer, because it is American. Let us breathe into our new-born insti- tjons—social, literary, scientific—the breath of life, and foster them in the arms of a deathless affection: Do for them, one and all, what you have come to do for your young and aspiring alma mater—cheer them on with our applause., and support them with our patronage! Young Gentlemen! You have two missions to execute—one of sci- ence and humanity, the other of freedom and national glory. In becoming physicians, you will not cease to be citizens. Most of you will, indeed, attain to both distinctions at the same time; and all should feel, and practi- cally acknowledge, the responsibilities of both characters. You have a profession to organize—a country to build up—a high destiny to fulfil. A heritage of great principles, requiring diligent cultivation, is. descending to you and the generation of which you are a part. Hand it down enlarged, purified, and embellished. Do your duty, your whole duty, and nothing but •your duty; and thus you will hasten on the day, when love of science, and love of constitutional liberty, and love of country, will unite in one deep and swelling emotion of soul; and the natives of eveiy hill and valley salute each other with the anthem—'We are Americans! Our forefathers were the first of the human race to plant the seeds of universal learning, Chris- tianity, and freedom, in the solitudes of a wilderness! We must honor their memory by emulating their deeds!' finis. I '•'.'•' '•''■,:i.',>-'■-. : v-'W'