Ih BE 0 T U IB. BE, ^ntrfliuutorn to t(je ttouw OF MATERIA MEDICA AND PHARMACY, IN THE MEDICAL DEPARTMENT OF PENNSYLVANIA COLLEGE. Session] of 1846-47. BY HENRY S. PATTERSON, M.D. Unica ejus cynosura sit gloria Dei, ac salus proximi; lemma et suprema lex sit: Deum colere, neminem loedere, ac omnibus velle prodesse. Provinciam suam Medicus a divina Providentii, per legitimam vocationem humeris suis impositam, attenta sollici- tudine, ac sollicita attentione administret,* * * cogitans, se redditurum aliquando desuper Beverissimam rationem, inmagno totius orbis conventu,ac sabbatho sempiterno. Weinhaht, Medicus Officiosus, c. i. "} ii. PHILADELPHIA: KING & BAIRD, PRINTERS, No. 9 GEORGE STREET. 1846. CORRESPONDENCE. —♦— Philadelphia, November 10th, 1846. Prof. H. S. Patterson. Dear Sir: In compliance with instructions from the Class in the Medical Department of Pennsylvania College, we have the honor to solicit a copy of your Introductory Lecture for publication. In communicating this unanimous expression, We have the pleasure to be, With much esteem, yours, &c. B, D. HOLCOMB, Pennsylvania. A. MAC DONALD, Nova Scotia. W. L. FOSS, St. Croix. G. W. KNOBLE, Germany. GEO. GUIER, Jr., Pennsylvania. E. W. CUNNINGHAM, Tennessee. WM. W. ESTABROOKS, N. Brunswick. JOHN SMITH, Virginia. H. BURKLEO, Illinois. H. A. JEWETT, Massachusetts. WM. H. HULL, Maryland. A. B. WILLIAMS, Michigan. THOS. S. HOLLINSHEAD, Pennsylvania. C, J. FREELAND, North Carolina. B. R. FITCH, Vermont. JOS. B. SUDLER, Delaware. A. F. M'INTYRE, New York. J. F. ADOLPHUS, Jamaica. CHRISTIAN BLASER, Ohio. JOHN E. WHITESIDE, Pennsylvania. Pennsylvania College, November ISth, 1846. Gentlemen : Your kind note, containing a request that a copy of my Introductory Lecture be given you for publication, is received. I regret that the Lecture is not more worthy of the flattering notice you have been pleased to take of it; but, such as it is, it is heartily at your service. Accept for yourselves and the Class, the expression of my high regard, and believe me Truly your friend, HENRY S. PATTERSON. To Messrs. Holcomb, Macdonald, Foss,) Qommmee Knoble, and others. J Jntr 00 actors—1846-47. A recent writer has said, that " the hunger of an age, is alike a presentiment and pledge of its own supply, for instinct is not only prophetic, but provident." The proposition may appear to some, rather an effort at imposing quaintness, than an expression of simple fact, and yet the entire history of our race is evidence of its truth. That instinct which directs the wants of an age, points to their adequate supply, and predicts its destiny. Always the prophecy of the heart fulfils itself. Prayer is many times its own best answer. The lofty aspira- tion of an individual or an age, for something higher and better, works out its own accomplishment. The future is contained in the present, as the plumule in the seed, and he who has the patient faith to wait the kindly influences of nature, sometimes slow but always certain, will see it ex- pand to the fulness of its beauty, true to its primal type. In like manner, every present time is foreshadowed in its past, and grows from it, as the branch from the stem. The ages of mankind are not dislocated and separate. They are links of one mighty chain. Hence it is, that the new thing ever seems so old to us. It is but of to-day, yet we have seen it before, and we wonder why it is so. No discovery was ever made in science, but had been partially made by another previously. When Harvey announced his theory of the cir- culation, men stood aghast at the boldness of the innovation, and girded their loins to do battle with the audacious reformer, but no sooner was the tumult appeased, than they perceived that they had suspected the very same thing before,and some of them had really announced it in terms that make one yet doubt whether they did not in some sense know it. Just so in philosophy. When we speak of Bacon as the great pro- mulgator and apostle of the inductive method of reasoning, we speak truly. Yet we know that Hippocrates, and, after him, every Hippocratic observer of medicine, had uncon- sciously used that very method, and laid down its rules for the guidance of others, although not in entire clearness, nor with a full persuasion of its value and universality. Columbus did not start upon his voyage of discovery, until the rotundity of the earth had been fully demonstrated, and then his infer- 4 ence became palpable. The same thing is apparent in the ethical history of our race. The great moral truth, which is to revolutionize the nations, and give a new aspect to the affairs of men, never comes unheralded. The aurora is ever there, as presage of the coming day. We date from '76 as a new epoch in the world's history, yet it would not be difficult to find the scattered portions of the political creed then pro- fessed, pre-existing, and only waiting for a symmetrical col- location and full expression. Even that highest and best revelation of truth, that ever beamed upon mortal eye, and before which, all others paled their glimmering light, was not without its forerunners. We, who now look back upon it, can see that the world then stood ready provided, and waited its coming. Its advancing glory rested first upon those mighty spirits that rose as far above their contemporaries, as the mountain tops are gilded with the morning beams, while all beneath them is still shrouded in darkness. It came " in the fulness of time," and the waiting multitude received it as manna from heaven, sent in the season when its need was,. most felt. Its promise was contained in all the past. So, in the sluggish and shapeless Chrysalis, the discerning eye of the naturalist will trace the lineaments of the painted Psyche, which will soon be seen basking in the sunshine, and soaring afar into the blue aether. We err grossly, when we regard society and institutions as built from without inwardly. It is not so. If it were, then were we wholly material. The reverse is the case. There is no more absurd spectacle on earth, than to see a body of men sitting down deliberately to organize a frame-work of society for others, or even for themselves. Unless it grow spontaneously from their natures, dispositions, habits of thought, feeling and action, it will fall to pieces before it is completed. The sad fate of philosophical constitution-build- ers, and the monstrous delusions of systematic world-reformers, sufficiently prove the fact. Hence the vanity of all attempts made by one people, to adopt the social and political forms of another and different people. Hence also, the failure of efforts to reproduce the past in actual life. The outward form must be moulded from within. It is the spirit that must shape the matter, and according as it is debased and deformed, or ex- alted and beautiful, so will that shape be. A free community presupposes a free, bold spirit. A tyrant implies a servile and abject people. The seeds of moral reform must be planted silently in the depths of each individual soul. That done, all else follows as matter of course. The mighty thought which fills full the heart of an age, will find or make for itself a fitting 5 garment. Its forms are the appropriate expression of its mov- ing spirit. They are the signs of the times, in which, who- ever is wise, may read its moral and intellectual condition and prospects at a glance. They are syllables in the mystic language of nature. Their history becomes the written record of the will of God, revealed through the mind of man. Even the architectural monuments of a people, speak their spirit as eloquently as the words of historian and poet. The crum- bling remains of the past are instinct with its mind: For, out of Thought's interior sphere, These wonders rose to upper air, And Nature gladly gave them place, Adopted them into her race, And granted them an equal date With Andes and with Ararat. All things in the world of matter and of mind, are obedient to eternal law. The bee builds his little hexagon according to forms impressed upon his being when the world began, and so does man construct the environment in which he mnst dwell. A wise thinker has said, that " Nature is the art of God," and the ruling principle of that art, is order according to fixed law. When we look back upon the dark abysses of the past, all would appear at first sight as chaos, before the vivifying light had shone upon it. Out of its gloomy depths, there come to us the mingled sounds of confused life, as the multitudes roll on toward their one dark goal; now hoarse murmurs of hate, and again tones of gentlest love; sometimes rising in joyful jubilee, startling the earth from its repose with sonorous strains of war, soaring on the wings of prayer, plain- tive with tenderest pity, or wailing sadly "de profundis," the burden of a boundless woe. Infinite discord ! Yet to him who listens in a wiser spirit and with a loving faith, it is not so. He will hear the jarring noises blend softly one with another, until they become to him notes in the mighty and unceasing world-harmony, whose soothing concord all that have ears may hear. That song began when the morning stars sang together for joy over a new world added to the myriads that deck the throne of the ineffable One, and will end only when the destiny of that world is completed. And the burden of that song is progress,—unity of effort in the three-fold creation,—matter, life, and spirit, tending to the one consummation. Clearer and more distinct, does strain after strain fall upon our ears. What once were to us harsh dis- cords, die away before the gentler sounds, and deep among all we begin now to discern that mighty ground-tone, which is the ceaseless tramp of the great army of Humanity across 6 the ages, toward the end, and under the law which its Maker and Master has ordained for it. Progress is written upon all the material creation. The geologist reads its record upon the sides of the primeval hills. He finds it engraven upon the ancient rock. Its evidences meet him in the caverns of the earth. It is equally the primal law of all organization. Motion is life, and stasis is death. No sooner have the vivifying influences given an impetus to the germ than it bursts its matrix, and commences its career of ceaseless activity, the first pause in which, is inevitably the last and only one. Sobernheim has well said, that the sum of life is expressed in one significant German word, Vorgang. Neither is this activity blind, aimless, and at hazard. It is under definite law, and to distinct ends. These accomplished, comes then the repose of death. So is it with the physical man, and so with the intellectual. Evolution, bloom, and in- volution, is the history of each and all. No bed of rest, but the grave, and even there, though the concrete mass may cease from its labours, the busy atoms will know no repose, but seek new combinations and new spheres of activity. If we examine the history of the human intellect and its labours, we will find proof and illustration of the same fact. Little by little has science been built up, by the combined efforts of all ages and nations. Like industrious ants, have the co-laborers brought each his little store to add to the general sum, and from time to time, there has appeared one whose greater grasp has enabled him to shape the mass into order and comeliness. In no other way can any human science ever grow ; and hence the impudent absurdity of all those new systems which pretend to neglect and despise the past. Minerva may spring full grown and armed from the forehead of an Olympian Jove, but not so is the offspring of man's intellect born. Its beginning must be in the microscopic germ, and the feeble bantling needs much careful nursing, let its after growth be what it may. Paracelsus, with the stupendous audacity that was so characteristic of the man, dedicated his book to all those " who thought new things better than old, simply be- cause they were new," a class of persons not yet extinct on the earth, nor apparently likely to be. He could publicly burn the books of the fathers of medicine, as useless, since superseded by his own, and yet the good old world went quietly on her way, and Hippocrates, Galen, and Avicenna, still hold the highest seats in the temple of medical science, while Paracelsus is remembered only as the prince of quacks. Such must be the fate of all who forget that progress is the law of science. Herein moreover, seems to me, to lie the 7 secret of a genuine eclecticism, which is for the most part un- conscious. I suspect a man who deliberately sets himself to work, to make a system out of scraps from those of others, even if that man is a Boerhaave, or a Cousin. His patchwork can never be that seamless coat, which alone can fitly clothe the fair form of Philosophy, as a symbol of the simple unity of truth. Yet Nature is eclectic for us. There is a spark of the eternal life in truth, so that it cannot die, while falsehood perishes before the moth. Cast your handful of wheat into the bosom of the kindly earth, nothing doubting that while the chaff decays and perishes, the living germ shall yet give seed to the sower, and bread to the eater. If then, the true word once spoken, never dies, and the successive generations of men are actively engaged in the investigation and discovery of new truths, the result will be a progress to end only with the limits assigned to it by the Eternal Wisdom. It was from a contemplation of the gradual advancement of learning, age after age, that the general idea of progress was deduced. The first distinct statement of the doctrine, is found in the treatise of Lord Bacon, De Augmentis Scientiarum. To the honour of our profession be it said, that the first attempt at tracing, according to this view, the development of a science from its obscure and contemptible beginnings to its present condition, was the history of Medicine of Leclerc. No one doubts the educability, and consequent progressive character of the individual, or of men in society. It consti- tutes the great and most evident distinction between man and the inferior animals. Whatever of acquired skill the latter may possess, dies with the individual. With the generations of men it is cumulative. The sheep that browse upon our hills, are in this respect, the same as those that fed in the primeval world upon the plains of Shinar. Yet there is a wide difference between the awe-struck shepherd who then looked up to the shining orbs above him, as the mysterious rulers of his destiny, and the modern astronomer who will measure each, and trace their devious paths over the immen- sity of space. These are well-known facts, but the doctrine of a similar progress on the part of the entire race, which we name Humanity, is not so generally recognized. It was un- known to the ancients. Ocellus Lucanus, although a Pytha- gorean believer in the system of pre-established harmonies, could see in the history of societies, nothing but successive birth and death, without any objector tendency of movement in the whole. Florus, in accordance with the same theory, compares Rome to a man passing through his stages of in- fancy, adolescence, virility, and senility. At the end was dis- 8 solution, with the vague hope of a renewal of the same sad round, but nothing more. Shelley has finely expressed this gloomy hypothesis in the closing chorus of his Hellas. The world's great age begins anew, The golden years return, The earth doth like a snake renew Her winter weeds outworn, Heaven smiles, and faiths and empires gleam Like wrecks of a dissolving dream. A brighter Hellas rears its mountains From waves serener far, A new Peneus rolls its fountains Against the morning star. 0 cease ! must hate and death return 1 Cease! must men kill and die 1 Cease! drain not to its dregs the urn Of bitter prophecy \\ The world is weary of the past;— 0, might it die or rest at last! The dawning of a happier faith, as mentioned, is first found philosophically stated by Bacon, although it is not to him that its origin is to be ascribed. It had a higher source. The ideas of the solidarity of men in Adam, and, more than that, in Christ, had their effect upon the early Christian writers, and especially upon St. Augustine. With the rise of the masses at the Great Reformation, and with them, of a popular liter- ature, these views acquired new force and clearness. It is true that the authority of the classics was still too great for Machiavel and the historical writers even a century or more later to get beyond the opinions just ascribed to Ocellus and Florus. Not long after Bacon, however, we have the pious Pascal stating distinctly the continual progress of all men to- gether, and adding that the race in all ages should be regard- ed as one man, who exists always, and learns continually. At the present day, the same opinions are generally received by the philosophical world, and the words Humanity and Progress indicate the prevalent opinion concerning the unity as to object and tendency of the race and its onward course. But, it will be asked, what have these considerations, inter- esting as they are, to do with us as medical men ? In what point do they touch the studies which we are now and here met to commence ? It seems to me, in many. In that pro- gressive augmentation of human knowledge, to which refer- ence has been made, medical science has its ample share. From its poor empirical beginnings in the isolated experiences of rude barbarians, it has gone through many vicissitudes to- wards its present condition. Nor has its career closed. It 9 is not yet, and never will be, time for us to fold our hands in apathy, and look upon the work as completed. Never was there a greater activity of investigation, or a more rapid ad- vancement in our science than at present. Microscopic research and the accurate minuteness of analytical chemistry, are bringing us daily treasures of knowledge of which our fathers never dreamed. And yet how much more remains undiscovered ! To believe that we can see the end, is as though the traveller, toiling up the steep hill side, should think that the road he has followed so long, terminates up there against the blue sky. Let him but reach the summit, and his path stretches away again over fields more beauteous than any passed before. Medicine is not a perfect, and there- fore not an exact science: otherwise no further progress could be possible. Progress implies deficiency to be supplied and error to be corrected. It may be doubted whether the perfection of our science will ever be reached. It may even be doubted whether the finite mind can ever grasp a subject so vast and so profound. It may be,—I believe it is,—decreed that end- less struggle and approximation should be the law of our intellectual being, the condition on which we have the ac- tivity of busy life, and not that sluggish indolence of posses- sion, which is mental death. Hence that pregnant saying of Treviranus, which Lawrence has pronounced wise as the famous choice of Hercules: "If the Deity held in his right hand all truth, and in his left only the ever-active impulse, the fond desire and longing after truth, coupled with the condi- tion of constantly erring, and should offer me the choice ;—I should humbly turn toward the left and say, 'Father give me this—pure truth is fit for Thee alone ." " Medicine being thus progressive, there is imposed upon us, and upon you, gentlemen, should you assume the offices of our profession, an important duty and a heavy responsibility. It is not enough that we practice the art of healing according to its highest known laws. It is not enough that we labour to acquire for our own use, or for the sake of teaching others, all that has been hitherto made known upon the subject. We must add to that store of knowledge. We must assist in promoting the onward march of our science. If we, as a profession, neglect to do this, it will be dorie for us by others. As Carlyle has remarked of another subject," if it is not done, it will do itself." Providence never waits upon those who are too indolent, too cowardly, or too proud to fulfil its mis- sion. If the invited guests will not come, then is the feast spread for them that are found by the wayside. We have had one example of this fact already in the history of medi- 10 cine. The haughty Galenists shut their ears against the wonders of chemical discovery. They would not accept the new truth, and it crushed them. Galenism was swept away before it, so that men, for a time, would not respect it even for the good there had been in it. It behooves us then to be careful that we never pause in our career, lest we share a similar fate. We must, above all things, avoid that pride of opinion which refuses to learn. We know not from what quarter the new truth may come, or who may be privileged to make it known. Come whence it may, it is our duty, as it is our interest, to receive, welcome and adopt it. There is another consequence, flowing from the doctrine laid down, to which allusion has already been made; that we should view with distrust those new systems which, from time to time, offer themselves as substitutes for all the learn- ing of the past. Such is not the method of nature, nor, con- sequently, of science, which is but the picture, more or less truthful, which man makes to himself of nature. I know that we have at times the discovery of some mighty fact, which gives a new aspect to that part of science to which it belongs; but it presents itself to us only as a fact, asking to be admitted into the great family of such, hitherto ascertained, and not pretending to be the whole truth of nature in itself. I know that when facts have accumulated, it may require the ap- pearance of some larger and more capacious intellect to ar- range them and give us their general expression or law, which will be but the complement of the truth already established, and not a revolution absolutely de novo of a different order of truth. New systems in medicine are always to be suspected. Their assumption of presenting a well- rounded and complete body of doctrine is prima facie evi- dence of their falsity, because medical science is based entirely upon other sciences, of acknowledged difficulty and obscurity, and some of them comparatively in their infancy. Medicine, or the curative art, disease, health and life form a series of intimately connected ideas, of which each depends upon the following one as its cause, so that all are finally referred to the last, or the idea of life, and find in it their true value and explanation. The curative process can only be conceived in connexion with that object, in regard to which it is a means of cure, and without which, it can have no real existence,— that is, disease. But before we can comprehend disease, we must turn our attention to that which is the ground of its existence,—namely, health. As in the physical world there can be no death without previous life, so is there no disease without relative health, for absolute disease would be death. 11 Disease is a departure from the condition of health, and the study of the normal state must precede that of the aberration, But neither health nor disease are entities, but merely modes of the vital activity. They are more properly regarded as healthy and sick life. We come then to the idea of life, as the primary one, with which the study of medicine must commence, and without a perfect understanding of which there cannot possibly be a complete body of medical doctrine, and even with which there is not necessarily such, much else being required. Very much has been done for the elucida- tion of these most abstruse topics, and it will be our duty here to teach you what is thus far known. The idea I wish to impress upon your minds at present, is simply this. All this wonderful fabric has been built up by the patient toil of the laborious learned in all past ages. We yet reverently turn to the venerable form of Hippocrates, and acknowledge our debt of gratitude to him for both fact and doctrine, and to thousands since his time. The giant intellects of many cen- turies, have esteemed it honour enough to add another stone or two to the edifice. What then think you of the pleasant individual who will,—like the pretended physician in the French comedy, when gently reminded that the liver used to be on the right side of the body,—confidently tell you that "we've changed all that,"—who will assure you that he,— the surprising individual !—out of his own copious resources has built up, tightly compacted and completed a new edifice, in which the weary student-world may at last rest from its labors, finding all things done to its hand ! Such a spectacle would seem too preposterous for us to believe that it could be presented under the sun, without exciting general ridicule, did we not know that it had been the history of every century since medicine first became a science. Asclepiades could im- pudently assert that nothing was known before himself, and yet become the honored physician of the imperial court of Rome. Paracelsus has been mentioned. With his doctrine of tartar, his panacea, elixir vitse, and animal magnetism, he convulsed the scientific world for a short season, and then died, a miserable drunkard and outcast, with a bottle of his panacea in his pocket. In Brown we have another example of the same arrogance, and in some degree of the same fate. Hahnemann is the most recent instance, and except Paracel- sus, the most presumptuous. Like his predecessors, he vio- lates every rule of sound philosophy, reasoning incorrectly from premises for the most part imaginary, and often palpably false. He boldly asserts that the true medicine was unknown until discovered by himself, and designates his method the infallible 12 oracle of the healing art, and sole method of curing disease. This method is included in four propositions, of which Dr. Stokes has remarked, that " it is hard to say which of them is most revolting to common sense!" By asserting that we must not seek the cause of symptoms, so as to combat thern by attacking the morbid condition out of which they arise, he reduces medicine from the rank of a science to a purely em- pirical handicraft. By his favorite maxim, " similia similibus curantur" he negatives that axiom of natural philosophy which teaches us that like causes produces like effects. By his notion that inert substances become medicinal in infini- tesimally small doses, he sets at defiance the teaching of Euclid,—that the whole is greater than a part. In fine, in his reference of all diseases to three original forms of syphilis, sycosis and itch, he makes one of those assertions soastound- ingly at variance with the every-day experience of every body, that it can be met only with the sufficient answer of —expressive silence ! I have cited these instances because striking from their absurdity. But the caution is not confined to them. There are other systems more dangerously attrac- tive to the educated physician, because having a basis of truth, and built of substantial materials, as far as they can be found to suffice. They have their origin with those whom I may designate as semi-dogmatists, those who do not entirely contemn experience, but who hold that we may reason where experience fails, meaning thereby that where a fair induction from premises ceases, the philosopher may call in the aid of conjecture and hypothesis. To these we may say in the lan- guage of Sir Isaac Newton : " I feign not hypotheses, for whatever is not deduced from phenomena, is called hypothesis, and hypotheses have no place in philosophy." As specimens of this false logic in medicine, I may instance the Italian doc- trine of Rasori and Tomasini, and the so-called physiological system of Broussais. Containing much that was new, valua- ble and practical, they yet became noxious by pretending to offer a complete expression of the ultimate laws of life in its normal and abnormal states. It is against such I would cau- tion you. Remember that true science is always modest, and distrust every boaster who pretends to have attained import- ant results by any other than the slow but sure way of a ra- tional experience, based upon the hoarded learning of ages. But there are social and ethical considerations of still greater importance, deducible from the doctrine with which I com- menced this lecture. The progress in question consists not only in an augmentation of human knowledge, but also in a gra- dual amelioration of the general condition of man, and an 13 approximation to the observance of the true laws of his being. This is not the time or place for entering into the history of this progress. For its details, I would refer such of you as may hereafter have the leisure and disposition for these studies, to the works of Cousin, Guizot, and DeBrotonne, and especially of one who is becoming equally conspicuous asa phy- sician, historian and philosopher, J. P. Buchez. I may merely remark that the original savage condition of men, (for that is historically their original condition,) is marked by a predomi- nance of the egoistic sentiment leading to general individual- ism and antagonism. Society of some kind must always have existed. Were there no other, there was at least the family, whose extension would give rise to the patriarchal authority. In process of time, when the social sentiment and the strength derived from union, caused men to band together in greater numbers, the individual was lost in the city. We have an example of this in the Greek cities, which were but concrete individuals, as it were, with a multiplied egoism and antag- onism. Their democracy, like that of Dr. Henry More's city of Onopolis, Is nought but a huge hungry tyrant train: Oppression from the poor is an all-sweeping rain. But with the rise of these societies generally, rose also the inordinate influence of the wiser and stronger, growing by degrees into absolutism and tyranny. In these ways we have formed republics and empires, differing in internal policy, but agreeing in selfish hostility to all mankind without their borders. Hence that false form of patriotism which classic authority continues to make prevalent even to our own day. In this form of society, civilization made mighty advances. The power of the combined forces of men was displayed in Egypt as we shall perhaps never see it displayed again. The aesthetic development of the Grecian mind will serve as a model to all coming ages. But the individual was lost. In the ecclesiastical despotisms of the east and the equally oppressive military forms of the west, the man was but an atom in the mighty whole, a thing to be used or anni- hilated at the pleasure of the ruler. Virtue is not predicable of a society where every woman is at the mercy of the lust- ful great. Benevolence and even justice are unmeaning terms where the right of the strongest is allowed. The last few centuries have shown the assertion, gradually growing more distinct, of the personal dignity and freedom of man as man. To this was necessary the re-establishment of a general individualism. The being, who was but a most 14 insignificant part of the great machine, found that he had a personal existence and value. He too was a man, with the mental and physical mights of a man, which mights also he could use. Hence your French Revolution and others of a like kind. Hence your Cromwells, who could "gar kings ken they had a lith i' their necks." Hence, in fine, your Declaration of Independence and its proud assertion of the inalienable rights of man. All this has been done. What then remains ? We can- not again attempt the subjection of the community in mass, in order to establish a limited and monstrously aggrandized communitism. We cannot continue in a condition of uni- versal isolation and antagonism. Our mission is to arrange an equal and harmonious socialism. We no longer teach, under the name of divine right, the self-abasement of all be- fore one; nor under that of patriotism, the sacrifice of all individual rights and privileges to a hypothetical tyrant, the state. Under the higher idea of divinely commanded duty, we are beginning to inculcate the self-renunciation of each for all, and all for each. It was a great work to establish the rights, dignity and self-sovereignty of the individual. They are now asserted, and we know that God has thus made each and all. In our philosophy we have established the rights of man, and in our practical workings we have shown the mights of man. Now we must go on to assert and establish the duties of man, which limit his rights and direct his mights. Such is the problem which it is given to our age to solve. Its first duty is to recognize the inborn dignity and value of every son of Adam. That done, the next step becomes clearer. The same gospel which teaches us that God is our Father, teaches us that man is our brother, having a claim to be treated as such. He who admits no mastership over him- self but a spiritual one, will claim none over others. He will perceive the difference between an observance of the social order and a submission to unrighteous authority. He will come to know the practical value of the golden rule. He will learn to love his neighbour as himself, and to recog- nize as his neighbour in this sense every member of the great family of man. He will learn to appreciate the sanctity of the temple of the Holy Ghost, which temple man is. Under the influence of these principles there must ultimately grow up a social form widely different from the mutually-hostile competitive industrialism that now prevails. And the mo- ment for their practical exemplification is even this. To brand these views as Utopian, or to postpone their accom- plishment to a far distant possible future, seems to me 15 atheistic. If they are false, away with them. If they are true, act them out at once, in God's name. We are always slow to believe that now is the accepted time. We need no waiting. It is our indolence and want of faith that make us so slow. Like Lothario in Wilhelm Meister, we must learn that" our America is here or nowhere," that our time of action is now or never. In this onward movement we, as medical men, have a deep interest. Independent of our intrinsic duties as men and members of society, we also sustain, by our professional ob- ligations, a peculiar relation to the great interests of humanity. We must not forget that the physician is set apart to the ful- filment of a sacred office. The learned professions, so called, have a higher warrant than the mere convenience of social life, or even the necessities of society. The industrial pur- suits of life are doubtless important and serious. They have their foundation in the nature of things, and are of the highest value. Far be it from me to depreciate them. I reverence honest and earnest labor. Honorable to me is the hard hand, incrusted with the marks of manly toil. In equal degree do I esteem commerce, with her myriad ships, the white-winged messengers of civilization and art. But the objects of these are altogether material. We profess a higher vocation. The triple command has gone forth, to preach the gospel, to heal the sick, and to defend the oppressed. We are among those who have assumed a compliance with these sacred injunctions. The end of our calling is to do good to our fellow-men. While our co-laborers go forth to spread the glad tidings of redemption, or to save the poor of the earth from the hands of the oppressor, our duty is to minister relief to the sick and suffering body. It is a most benevolent and unselfish office, and can be filled successfully only where there is a single-eyed attention to its great object. Hence it has been held in honor by men in all ages. Among savages, the "medicine-man" is reverenced as the possessor of supernatural powers. In the earlier civilizations, the offices of the priest and physician were always conjoined. " Give place to the physician," says Jesus, the son of Sirach, " for the Lord hath created him; let him not go from thee, for thou hast need of him," Frequent illustrations of the high regard in which medicine was held, and the exalted character ascribed to its professors, are found in mythology. Among its presiding deities the Egyptians placed Harpo- crates "labia digito comprimentem," to signify the cautious reserve of the physician. Apollo was accompanied by the Graces, according to Weinhart, not so much to indicate the 16 invention of music and song, as to denote that the physician should be humane, gracious and affable. The Syrian Apol- lo was bearded, to designate his matured manly judgment and prudence. The same meaning is found in the serpent wound about the staff of Esculapius. We are told also that the Lacedemonians made the statue of this god of the agnus castus, to point out the purity of the good physician. The title of Opifer was given to Apollo in his medical capacity, to signify the blessings conferred upon mankind by the heal- ing art. All these attributes are summed up in the proud title given to the physician by Hierophilus,—Manus Dei,— the hand of God. In order to fill such an office, according to its perfect ideal, one should possess a soul purged of self- ishness and sensuality. His first and most ardent desire must be to do good to his fellow men. He must rise so far above all the artificial distinctions of society, as to see his proper field of labor wherever a human being languishes in pain. He must feel that he is called upon to administer re- lief, wherever the need for it exists. He must share the martyr-spirit which is willing to spend and be spent for the good of others, and must be willing to renounce self and all its delights in order to become a servant and help-bringer to every member of his great brotherhood. But this is the same spirit of self-renunciation and devotion which I have described as being the ethical result to which our age is tend- ing. We are merely beginning to apply universally that idea of duty which has always been held to apply to our profession. We perceive, at last, that a high standard of Christian morality requires us to carry into every part of our social and humanitary relations the same principles which our forefathers have prescribed for the relation of patient and physician. If, then, the world around us is beginning to acknowledge its duty to carry out the exalted ethical ideal which has been held true in regard to the medical man, the query at once presents itself: Does the profession as a body appear to be actuated by these principles, and to attempt the realization of that ideal ? This is a question of deepest moment, and one to which an affirmative reply cannot be given without some hesitation. I fear that we too often forget to what we are called. There is great danger that we look upon our profession simply as a means of gain. In a commercial age, and among a mercantile community, this is a tendency diffi- cult to resist. Yet there is no spirit more fatally at variance with that which actuates the good physician. It is the most frequent and pestiferous source of quackery in all its shapes, 17 both extra and intra-professional. It leads to deceit and dis- honesty. It degrades the physician, and injures the patient. It destroys that simple truthfulness of mind, which is essen- tial to the successful practitioner. It causes him, when the life of a fellow being is in his hands, to abandon the dictates of his own better judgment in order to sail before the wind of an ignorant but popular prejudice. It converts him who should be a messenger of peace into an exactor and op- pressor. In the case of the Weak-minded it may open an avenue to1 crimes at which nature shudders. Our criminal calendars show cases in which the physician, stimulated by the accursed thirst of gold, has prostituted his professional skill to the concealment of guilt by a still blacker guilt. I know that these cases are extremely rare, but the fact that they have occurred is enough to arrest attention and make us look to their source. There is no absolute security against them, when once the lust of gain has possessed the mind. It should be most scrupulously guarded against.* In no other way will the physician be enabled to act up to the moral standard of his profession, and in no other way can the standing of that profession be preserved. Our office is a peculiarly benevolent one, and accordingly as we fill that office with faithful efficacy or not, so will our judgment be. The work of every man and of every body of men will be tried with fire, and the hay and stubble will be consumed If we binid with such, our doom is sealed. The good or bad issue of our course will follow as naturally as the grass springs from the moist earth beneath a genial sun. If We turn aside fro'm the path of duty on which we have voluntarily * I know nothing more apposite to our subject than the following elo> quent passage from the Medicus Officiosus of Weinhart, which might have been as well written on this side the Atlantic and in the nineteenth century. " Viiet insuper avaritiam, cavendo, ne non tam Medese, id est, artis Medicaa gratia, quam propter vellus aureum vela faciat, no Vulturis instar fu'cris et fapinae inhiantis, Eegjros continuis suis petitionibus, exactionibus et pactis ab insi^ni vet sorditie, vel plurophilid profectis, t'atiget et exhauriatj ne lucri cupidine in exiremam turpitudinem adactus, larginra pre in Fa au stipendia sperans, morbos aegrotantium protrahat, vel morbum leverti ita periculo^um exaggeret, extendat ac amplificef, u't sub facfe auxiliand?, praxirt depilandi, loculosque emungendi exerceat: tre experientiolas aliquas nullis forsan rationibus innixas, vel secreta opinativa et imaginaria, empy- rico supercilio ac hyperbolico praeconio decantans, perquam studiose velet, colet et custodiet, ut segri, etiam dato copioso auro, ab eo tafia remedia velut ex captivitafe redimere necesSe habeant; ne cum Pharmacopce'is con- cors, paniatur lucrum, levissimo in morbo pretiosissima praescribens medi- camenta; ne tandem, auri fulgore excaecatus, eo protervitatis, petulantiae ac perversitatis perveniat, ut venena propinet, abortum procuret, sterilitatena inducat, falsimonium fide ji/ratd probet, alialque christiatio Medico indigtia et scelerata committet." P 18 entered, in order to convert our noble office to a vile huckster- ing, we may in the end hear the same awful words of con- demnation that rang in the ears of him who would have bought the gift of the Spirit with gold :—Thy money perish with thee! In all these remarks, I do not wish to deny that a reward is due from the person relieved to him who brings that relief. As the practice of medicine is incompatible with any other pursuit, and requires a whole life-time of devotion to do it justice, there is a necessity for such a system of compensa- tion. I will not take it upon me to decide whether it is more proper and honourable to regard that compensation as an honorary fee or a legal debt. I believe that the intrinsic value of the services of the physician in the preservation of life and health cannot be represented in money, and on the other hand I believe it is more convenient that some standard of equivalents should be adopted, however arbitrarily. Be these things as they may, it is certain that with the good physician the idea of remuneration should always be se- condary. His first duty is to heal the sick. This is the les- son I would wish to inculcate upon you all, gentlemen, on the very threshold of the profession which you aspire to enter. If you have looked to medicine as a money-making business, be at once undeceived. Properly pursued it may yield you a competence, and perhaps more. Perhaps, on the other hand, with all faithfulness on your part, the reward may be poverty and obscurity, sweetened only by the testi- mony of an approving conscience. You are coming upon the stage of action at a time when the physician, more than ever, will be expected to exemplify the ideal excellence of his vocation. It will be demanded of you by the advanced ethical theory of the age. If you are prepared for this, the field is before you. Enter ye into the vineyard and labor, knowing that ye shall receive that which is right. I have thus endeavoured to show yon, gentlemen, that in the profession to which you seek admission, your duty will be not only to preserve its honour unspotted, and to maintain unimpaired its stores of wisdom, but to assist in its onward progress, so that it may keep up with the giant strides of other sciences, and the ideal standard of the age. This is no light labour, but one that grows heavier as it advances. You must look forward to a life of toil, if you are true to your profes- sional duty. There must be no pause in your career. We are not sent here to live at our ease and serve our appetites, while the world's work lies unfinished about us. In our in- dolence and indifference, when we would so often lie down 19 to slumber and dream, and let the noisy world roll on without us,—even when, worn and weary, we would fain turn aside from the turmoil and the strife, and rest in some shady nook, whose coolness might give a foretaste of the everlasting re- pose for which we all sometimes sigh,—it would be well for us to recall the stern reply of the fiery Arnaud to his peaceful friend Nicole, when he longed for a calmer and deeper rest than the quiet shades of the Port Royal could give,—Will you not have all eternity to rest in ? This time of labour is small indeed, when compared with the infinite ages of our Sabbath, and if its out-comings do in any way fix our destiny there, it will be a comfortless retrospect to look back upon its waste and neglect. Curpe diem is a good motto, though not in the epicurean sense intended by Horace. To-day is ours, and the man who feels that he has a work to do, as every true man must feel, should bend all his energies to the task, as one who knows that to-morrow may be too late. I conjure you, if you enter the profession, not to forget this sacred injunc- tion : Work while it is called to-day, for the night cometh wherein no man can work. Hot and dusty though the brick- field be, and heart and flesh fail, never slacken your labour until He who sent you shall call you home to take your wages. Then can you He down to your long last sleep, in the sweet consciousness of duty accomplished, and good done, and sink in peaceful repose into the bosom of the kindly mother, who bore and sustained you, confident that the Father of your spirits will have them forever in His holy keeping. The time to be consumed by our session, is one of deepest consequence to you all. You have left, most of you, your distant homes, with all their dear sympathies and quiet retire- ments, for the crowded thoroughfares of the sinful city. But your memory lingers there in many an anxious breast. For you, the fond breathings of parental love, rise in the morning and the evening prayer. Fond and gentle hearts are, perhaps, at this moment painting to themselves the scene of your re- turn to your childhood's home, in colours bright as poet's dream. Perhaps too, a dark shadow sweeps over the glow- ing canvass of their imagery, as they picture to themselves the thousand dangers of the metropolis. Well may they be anxious, for they know the value of this passing moment to each of you. It is the turning point of your lives. Freed from the restraints of boyhood, you now stand at " the part- ing of the ways." From infancy, you have hitherto travelled on a flowery path, hedged in on both sides by all the sweet and gentle influences of home. Now, two roads open before you, and you are called upon to make your choice. Which 20 shall be yoUrs ? The one, rugged and thorny though it may be, leads upward to higher regions and a purer air. The other, attractive at the outset, leads by a steeper and steeper descent, down to the depths of shame and wretchedness. The use you make of the opportunities now afforded you, will de- termine on Which of these roads your feet shall tread. I knew that too many of us never stop to inquire whither we are tending, until we arrive at our goal. In spite of the thousand lessons that may be read all around us in the history of others, we will learn of no master but that hard one, Experience. So true is it, that ftight brings out stars as sorrow shows us truths ; Though many, yet they help not; bright, they light not. They are too late to serve us; and sad things Are aye too true. We never see the stars Till we can see nought but them. So with truth. And yet, not always so. We see indeed, enough about usj in the manifold experience of life, to impress upon us this gloomy philosophy, but we should remember, that it is the accident, and not the law of human condition. To you it is left to say, whether such shall be the sum of your history or not. You are no poor victims of circumstance, left to drift down the current of events, at the mercy of every wave. To each of you is committed the strong energy of a manly nature, to stem that current, if you will, with undaunted breast, and fix your firm feet on a foundation, sure as the Rock of Ages. You are now first called upon, to say whether you will dis- play that energy. You remember the story of Hercules and his counsellors. By the side of each of you at this moment, stand those two : the one is Pleasure, offering you enervating and unreal joys ; the other is Duty, demanding a life that is pure, lovely and true. Which will you have ? is the question put by Providence to each of us. The answer, be it what it may, will be written, in ineffaceable characters, in the history df the coming months. May that of each of you, gentlemen, be traced in characters of Irving light, and may you leave us, when the hour of our separation comes, stronger, better, and more fitted than you ever yet have been, to act well the part of true men, in the busy drama of existence!