INTRODUCTORY LECTURE 
TO THE STUDENTS OF THE 
MEDICAL SCHOOL OF HARVARD UNIVERSITY. 
WEDNESDAY, NOV. 4, 1868. 
By CHARLES E. BUCKINGHAM, M. D., 
PROFESSOR OF OBSTETRICS AND MEDICAL JURISPRUDENCE. 
BOSTON: 
PRESS OF A. A. KINGMAN, 
MUSEUM OF THE BOSTON SOCIETY OF NATURAL HISTORY. 
1 8 6 8. INTRODUCTORY LECTURE 
TO THE STUDENTS OF THE 
MEDICAL SCHOOL OF HARVARD UNIVERSITY. 
WEDNESDAY, NOV. 4, 1868. 
S 
By CHARLES E. BUCKINGHAM, M. D., 
PROFESSOR OF OBSTETRICS AND MEDICAL JURISPRUDENCE. 
BOSTON: 
PRESS OF A. A. KINGMAN, 
MUSBUM OP THE BOSTON SOCIETY OF NATURAL HISTORY. 
1 8 6 8. Boston, Nov. 9, 1868. 
Dr. Charles E. Buckingham: - 
Dear Sir : At a recent meeting of the Class, it was voted that a committee 
be appointed to request a copy of your Introductory Lecture for publication. 
As that committee, we would inform you of, and respectfully desire your com- 
pliance to, their wishes. 
Very truly yours, 
Charles B. Brigham, 
Horatio Bridge. 
Boston, Nov. 10, 1868. 
Messrs. Charles B. Brigham and Horatio Bridge: - 
Gentlemen: I shall be most happy to accede to the wishes of yourselves 
and friends, as expressed in your note of to-day. 
I am, very respectfully, 
Yours, 
Charles E. Buckingham. ADDRESS. 
Gentlemen : - 
I welcome you in the name of the Faculty of the Med- 
ical Department of Harvard University. It seems but a 
few months ago that I was one of the audience at my 
first introductory lecture; yet twenty-eight years have 
passed since, as a student, I knew the Massachusetts Med- 
ical College. The staff of the College then consisted ot 
six professors and the demonstrator of anatomy, and the 
graduating class numbered about twenty. The graduates 
of the last year were more in number than the whole 
school for that year, and the officers of instruction, includ- 
ing those of the Dental Department, have increased from 
seven to thirty-three. Of those who then filled the pro- 
fessorships, two still live; the original incumbents of the 
chairs of Materia Medica and Obstetrics, whose appoint- 
ments bear date more than a half century ago. It is a 
pleasure to find them still with us, and interested as much 
as ever in the progress of medical science, and in the in- 
stitution which is largely indebted to them for its prosperity. 6 
In assuming the obstetric chair, which was established 
in the year 1815, I find that both of my predecessors 
are with us, and I can only hope that my efforts to 
instruct and please may be received with as much satis- 
faction as the vivid descriptions of the one, and the 
enthusiastic comments of the other. The ready pen of 
the elder has instructed and enlightened many of us in the 
true management of " Bed Cases," and the prompt action 
of the younger has given courage to many a young man. 
To the latter gentleman the Tremont Medical School 
owes its birth, and from that the summer school of Har- 
vard University originated, by the stimulus of another 
organization whose days were less long in the land. 
The preface of a book is generally the last portion 
written. Could the prefatory lecture be the last to deliver, 
it would be an easier task, inasmuch as it might give you 
a synopsis of all you had heard, and refresh your memory 
for an examination. But our valedictory generally comes 
from an outside party, who can know but little of the 
particular labor which we are interested in. To my lot 
has it fallen to give the introduction of one to the other, 
and you will not take it amiss, should it be a lecture of 
advice. 
I welcome you to the study of an agreeable but ardu- 
ous profession; full of pleasure, full of toil. It has its 
dark and its bright spots. It is progressive in its course, 
and by its influence upon the public, we believe that the 
average age of man at death is coming nearer to that 
which is called old age. You have come together to re- 
ceive a medical education. Some of you are from colleges 
and high schools, where you have been subjected to cer- 
tain laws, which doubtless were irksome, but necessary 
under surrounding circumstances. Every officer of instruc- 7 
tion was also an officer of police, and every successful 
attempt to elude his vigilance was probably looked upon 
as a good joke, or a lucky hit. It is supposed that you 
entered those institutions by the wish of parents or guard- 
ians. We presume that you come here by your own 
choice, to study a profession for which you think your- 
selves fitted, and which you intend to make the business 
of life. The officers of instruction have nothing to do 
with police affairs, and expect to meet you as gentlemen 
and fellow-students, engaged in the same investigations. 
This season an additional school begins its work in con- 
nection with the Medical Department and by invitation 
of its Dean I address also the students of the Dental 
School. All that is to be said is as applicable to one as 
to another. 
I speak more particularly to those who are here for the 
first time. You have come to study medicine. Have you 
fixed upon any special branch of the profession which you 
intend to follow out ? If so, I would advise you, that you 
will probably change your intentions several times before 
you acquire the wealth which you see flow into the hands 
of some successful specialist whom you admire, and which a 
vivid imagination shows will be surely your stream. Except 
quack specialists, the successful ones are they who were 
good general students. Study the whole profession, not a 
part of it; and time and opportunity and accident will 
show, twenty years hence, what branch you are best quali- 
fied for, or whether you can get a living by the practice 
of any. To be a successful surgeon, you need to study 
all that the physician needs to know. To be a successful 
physician, you want a surgeon's education. The best 
practitioners are very likely those who are most often in 
doubt, and feel their own ignorance ; and the most faith- 8 
fill has sometimes to bewail his error in diagnosis. After 
a femur has become dislocated by disease, it is too late for 
the physician to wish it had looked less like rheumatism 
of the knee. After the surgeon has struck his trocar into 
a foetus, it is too late to think that it looked very like 
dropsy. It is too late to wish you had studied chemistry, 
after you have been called to a patient who has an acrid 
poison in his stomach. Yet similar accidents have hap- 
pened to men who stood well with the profession, and 
were thought good students and faithful observers. The 
more reason why, as students, you should undertake the 
study of the whole of the science, or none of it. He who 
undertakes to learn all of medicine and surgery that he 
can, will naturally fall into the place for which he is best 
fitted, whether he become a distinguished physician, an 
eminent surgeon, a thorough dentist, or a cutter of corns. 
Within the memory of students of my own age, there 
was a time when specialists were few. Every physician 
was supposed to have qualified himself for anything which 
came along. Into the hands of a few the business of the 
oculist had gradually fallen, and dentistry had become a 
special branch. But no physician in this community felt 
that he could not wipe a foreign body from the eye, nor 
extract a tooth for one of his friends, nor wash the hard- 
ened wax from a neighbor's ear. And it was natural 
that inborn or acquired dexterity, in any branch of prac- 
tice, should, in time, bring the greater part of such work 
into the hands of those of more particular skill. But 
those who became the specialists, were educated in the 
whole science, as though they were to go into general 
practice. 
Your duty as students is general observation and prac- 
tical study. You may not have the taste nor courage to 9 
perform an operation with the knife, but you have no 
right to be so ignorant of anatomy that you cannot find 
and compress the vessel which supplies a wounded part. 
You may not care t.o remove a cataract, but you have no 
right not to know how to turn over an eyelid and remove 
a cinder. You may not fancy the dabbling in crucibles 
and test tubes, but you have no right to make yourselves 
ridiculous, by writing for liquids to be taken in drops, 
when after mixing they will be solid; nor for powders 
which will run through the papers in which they are 
folded. You have no right to mistake an ulcerated car- 
tilage for rheumatism, nor a dislocated shoulder for a 
bruise. You have no right to treat for facial neuralgia 
an abscess underneath a tooth, nor to say that a man who 
was picked up in the street with apoplexy is dead drunk, 
because he is in the station-house. Yet all these have 
happened over and over again; and unless you. study the 
whole profession, the day is likely to come when the 
errors may be yours, and when you will wish for the in- 
formation which you thought belonged exclusively to others. 
Medicine is a science. It is based upon observation. 
He who is the most acute observer is the best practi- 
tioner. The collection of statistics will not make you 
acute observers. That is a useful part of the work, but by 
itself is of no value. Every sense must be cultivated, 
for the senses are not alike acute in all. One can tell 
by the eye, another by the touch, a third only by the 
tape, if the two sides of a chest expand alike. But he 
is the better observer who tries the three, and allows one 
to correct and confirm the others. He is the best ob- 
server who can use one method, when the comfort and 
convenience of the patient will not allow the others. 
A physician of great experience, so called by the public, 10 
is by no means the man to whom we of the profession fly 
for advice, when we are in doubt. We appeal to the man 
of observation. Oftentimes you will find that use and 
large practice do not purchase professional respect, for we 
soon find out that one man learns more from the faithful 
observation of one case of fever in a year, than his neigh- 
bor learns from fifty. One man has seen a case daily for 
weeks, without observing a sluggishness of the pupil, or a 
slight irregularity of the pulse, or a very moderate distor- 
tion of the tongue, which tell to his more observant con- 
sulting friend, that he would do well to test the compar- 
ative sensibility or mobility of the extremities, and suspect 
a lurking disease of the brain. One man is for dosing a 
bilious disorder, which a sallow skin indicated to him ; 
while the observer sees that the complexion is of pearly- 
bluish wdiiteness, and the lips and tongue and gums are 
ill supplied with blood, and the veins of the hands have 
changed to a pinkish hue from anoemia. One is surprised 
that he cannot remove this headache by cathartics, when 
his brother who observes, astonishes both patient and phy- 
sician by a stimulant, which carries it off. One blisters 
and leeches an apparently inflamed knee without success, 
and is reminded of hysteria only when the man of obser- 
vation suggests the exercise of the part. The first is un- 
successfully treating a phthisical cough, when his brother 
surprises him by inquiries, the answers to which show 
that indigestion is the disease. Croup, which was the 
monster that X was combatting with emetics, and poul- 
tices, and steam, Y, whose ears and eyes are better edu- 
cated, relieved at once by suggesting the use of a gum 
lancet. And the chances are that our non-observing 
friend will cut the gums afterwards in every case of 
croup, or give pepsin for consumption, or brandy and 11 
water for the headache, or oblige some patient with an 
ulcerated cartilage to take up his bed and walk. 
But the work of observation is a hard work. Some of 
you will be acute observers from the start, and some of 
you may be very dull; but the observing powers of the 
best may be improved, and the apparently dullest man of 
all may astonish his friends by the keenness of cultivated 
powers. Still it is only by labor, and properly directed 
labor, such as medical schools intend to supervise, that 
the end is to be accomplished. In the words of one 
whom I hoped to see among us to-day, and whom as a 
boy I listened to at Cambridge, " Difficulty, struggle, 
progress, - this is the law." 
How is your observation to be cultivated ? There is 
time enough for the great majority of you. Do not run 
the risk of being superficial, nor of ruining your own 
health by undertaking to crowd too much into one year's 
course. The dissecting room, the laboratory and Materia 
Medica, are enough for the first year, if you visit hospitals 
and endeavor to become familiar with the appearance of 
the sick, the anatomy of the living, and the physiognomy 
of disease. But to know the anatomy of the living, you 
must take the dissecting knife upon the dead. You can 
never learn the tongue of the sick unless you examine 
the tongue of the well. Your study of abnormal dis- 
charges will be of comparatively little value unless you 
examine those of health. It will be of slight consequence 
in your practice to know the origin and attachment of 
all the muscles which extend the back; but your obser- 
vation will be of the greatest service, if you can tell 
what parts a knife will traverse, if thrust into the abdo- 
men directly or obliquely, at a point four inches to the 
right or the left of the umbilicus; or how to stop by 12 
compression or otherwise, the hemorrhage from a bullet 
through the centre of the hand; or the direction and 
effect of a sword between any two ribs, a few inches 
more or less from the spine. 
The constant tendency of students is to theorize, and the 
more they advance in the profession, the stronger the 
tendency becomes. Battle theory with observation, and let 
your observations contend with each other. One observa- 
tion proves as little in medicine as in any other science. 
We know but little of the different forces operating within 
our patients, and to lay down rules deduced from single 
cases is absurd. Age comes into the calculation, and so 
does the diet. The situation of this house had an effect 
upon this patient, so did his air-tight stove. The family 
surroundings influenced her insanity; so did a young man 
in the next village. This one had his feet frequently 
wet, which gave him his cough; his mother died of 
phthisis at his age. That one grew thin, and that one 
grew fat, as soon as they began to work in the mill; but 
Jane was in the midst of cotton dust, and Anna was 
handling greasy wool. Constant fever was in the finest 
house in town, while the next door was free from it; a 
change in the water-closet pipes made them equal. This 
patient began to recover as soon as he took wine; but he 
began with meat on the same day. This patient's dyspep- 
sia troubled him till he began smoking, and that one's 
left him when he stopped the use of tobacco. 
Your theory must follow the observation, and not your 
observation the theory. One case proves nothing. Ten 
cases prove nothing. All the cases for a year are but a 
feather in the scale. Years ago, men said that painting the 
borders of an erysipelatous patch with iodine would cut 
short the disease, because they had seen it stop at that point 13 
after its use ; but any man of large observation has seen it 
crawl over the line. That spot was not the disease, but 
only one manifestation of it. I once gave ten grains of 
compound cathartic pill to a patient who seemed about 
to have a violent dysentery, to give him a clearing out, 
preparatory to an opiate course, but he had no dejection 
for three days after. A few such cases might prove to 
many the astringent effect of aloes and calomel and the 
like, and their friends who knew them to be experienced 
men, would follow the track, though nineteen of their 
patients should die out of every twenty. 
Have any of you established your belief in any system 
of medicine, and come here to get quasi certificates of 
qualification ? You are quacks from birth, and would do 
as well to put up your door plates now, as to waste your 
time and money in three years of pretended study. You 
will be just as much quacks with degrees as without; and 
you can make more money as irregular than as regular 
practitioners. 
We wish for students, those who intend to follow out 
medical science, and aid us in its advances as far as they 
can. For what any one believes we have no fault to 
find with him; but we do find fault with him sometimes 
for his manner of obtaining his belief, and still more, if 
he bends anything, however true, in a false direction, to 
establish his belief in others. 
A man may honestly practice homoeopathy, or eclecti- 
cism, or allopathy, if any one can tell what that is. He 
may be a knave or a fool in the practice of either. He 
may work industriously to establish the truth of any- 
thing he believes, shutting his eyes to all proof of any 
truth in an opposite direction, and he is simply a fool 
quack. But if he steps a little farther, and puts his be- 14 
lief upon his sign, and endeavors to convert the public by 
professional preaching, he is a knave quack, with whom 
an honorable physician will have no intercourse. It is not 
a man's belief in one system or another, that makes him 
a regular or an irregular practitioner. There is almost as 
much difference of belief concerning methods of treatment 
among regular practitioners now present, as there was 
difference of practice between Hahnneman and Sangrado. 
Their arguments, however, are to each other, and not 
to the public, whose knowledge of medical science is equal 
to our knowledge of the science of gunnery. 
The most contemptible of quacks is he who stands ready 
to sit on two stools ; the man who tells his patient that 
one system, as he calls it, is good for children, and an- 
other is often required for adults; who doses the parent 
and big brother with senna and salts, and the child with 
sugar plums ; who either has not the courage or honesty 
to say that he thinks the patient will get well without 
drugs, lest some one may be sent for who will give them 
and deprive him of fees; who pretends, in one house, that 
disease is only to be cured by medicines which produce 
the symptoms of it, and in another, by medicines which 
produce the opposite set of symptoms. Yet you will find 
such men in the profession, who do their teaching to 
patients, but nevei' talk nor write to the profession. Some 
of these men associate with the regular physicians, and 
seme of them read papers on homoeopathy at homoeopathic 
conventions. 
Gentlemen, in the words of him whom I quoted before, 
" Strive to be a whole something." 
Medical observation will show you that the medical 
world, as well as the other worlds, is filled with fashions. 
There is fashion in disease, and fashion in treatment, and 15 
he is sometimes considered a bold, a rash, yes, an unscru- 
pulous practitioner, who dares not to follow in the general 
train. The day has been, when each disease was supposed 
to be a tangible enemy, for the destruction of whom there 
was a particular weapon; and after learning his name, it 
only remained for the physician to select from his armory 
the proper material of offensive war, and pour it in with 
a sufficiently lavish hand. Heroic practice was the rule, 
and the weapons were the result of theory, and sometimes 
of imperfect observation. Indeed, at this day, there are 
those who follow the same style of treatment, and who 
would really feel guilty on leaving a patient without a 
dose. But change has long since begun, and within the 
last third of a century, medical men have tried to see 
how much can be done with the least drugging. In this 
the honest practitioner of homoeopathy has unwittingly 
helped the observing physician, inasmuch as it was appar- 
ent that the small sugar globule supposed to be impreg- 
nated with an aura was often followed by relief, and he 
was led to let some patient get well without medication, 
who would otherwise have been dosed. And here let me 
say, that you should keep your observing powers awake, 
and not fail to make us.e of every circumstance which 
can be of the slightest use to your patient, whether it 
come from a regular physician, a pretending quack, or an 
amateur nurse. 
Observation will show you that changes in the fashion 
of clothing will produce changes in the fashion of disease. 
Fashion makes and prevents sore throats and rheumatism. 
Gentlemen now present will remember, when the high 
pockets for the hands in outside winter garments, some 
twenty or more years ago, introduced the fashion of frac- 
tured olecranon, which would otherwise have been pre- 16 
vented, as the low pockets, a winter or two ago, gave a 
fractured wrist for the fashion in those who fell. 
You will observe that fashion arranges the hair, and 
settles the style of ear freezing. She decides the height 
of boot heels, and arranges the bumps upon the skull in 
those who slip. She decides upon the width of the sole 
at the toe, and fixes the number of corns; the width 
below the instep, and the consequent firmness or weak- 
ness of the ankle joint. She commands the extent of 
neck and waist to be uncovered, and the proper propor- 
tion of pleurisies and pneumonias to follow. When you 
find, by observation, any class of accident or disease pre- 
vailing with unwonted frequency, let your observation 
work out the cause, and, if possible, establish the fashion 
of prevention, which is always worth more than a cure. 
Even here there is danger that you may let theory have 
the advance of observation, though you may have an ob- 
servation at the start. Do not trust observations which 
are not recorded, and if you read your record of last 
week, you will frequently find some fact omitted which 
to-day you know, and which comes again to-morrow, and 
changes your whole plan of treatment for the future. 
What is it to be bilious? Not a man in this room has 
probably any very distinct idea of the meaning of the 
term. Yet it has been the fashionable disease, and al- 
ways will be with the quack pill maker. Before the 
days of written observations, it was the fashion with all. 
It was profitable to the doctor and the druggist. It was 
the day of blue pill and cathartics, of purging and puking, 
when as much medicine was poured into a child who had 
eaten too many buckwheat cakes, as an educated veterinary 
practitioner would give to-day to a sick horse. 
It was theory and not observation, which gave us the 17 
fashion of spinal irritation, the disease of every third 
woman in the hospital, when I began my studies. Ask 
what it meant. No one can tell you. Still later, and to 
take its place, came diseases of the womb, and as these 
have unfortunately become to some extent a class of dis- 
eases treated by specialists, we shall know less of them 
ten years hence, than if the specialist never existed; for 
many specialists see but one thing, and that is the one 
thing they are always working for. At the rate we are 
now going on, by the end of this generation, it will be a 
rarity to find a vagina of fourteen years which has not 
received its pessary, or a cervix uteri which has not been 
probed by some fashionable practitioner of medical mastur- 
bation. 
In its turn came diphtheria; and every sore throat, 
whether it had a membranous exudation or simply a 
white sebaceous protrusion from its follicles, was diphthe- 
ritia in M's practice, though N's, with the majority of us, 
had seldom or never seen the disease. This was because 
M had not been in the habit of observing throats, until 
the medical journals and the daily newspapers talked 
about the ravages of the disease. 
Not many years ago a similar, but less virulent fashion, 
accompanied with cough, was the clergyman's sore throat, 
bronchitis, as it was sometimes called, and the sponge 
probang was rammed into the aesophagus of him who 
coughed ; and to-day the observing physician sees the 
granular fauces of many of the victims who patiently 
submitted to the canonical treatment. 
Since the publication of Lallemand's book on sperma- 
torrhoea, and the observation that very many insane men 
masturbate, the theory that masturbation is the very fre- 
quent cause of insanity has been the fashion, without ob- 18 
serving whether it may not generally be a symptom rather 
than a cause. Some physicians are ready to allow that 
every nervous boy or man indulges in the vice, though 
very few of them ever saw the spermatozoa in the dis- 
charges on the shirt. The benevolent and the quack 
encourage the delusion, and by their lectures and books 
have taught masturbation to those who otherwise never 
would have thought of it ; books which are read for the 
sexual excitement they produce ; books which might well 
be replaced by Humphrey Clinker and Tom Jones, be- 
cause the latter do not teach the unnatural act, and do 
not lead to the counting of wrinkles, and the examining 
of dark swellings below the eyes ; do not lead to the fear 
of insanity, and thus produce it. 
There are fashionable medicines. Keep your observa- 
tion at work upon them. To omit the experiment with 
some drug, which a friend thinks he has found most use- 
ful, seems impossible ; but beware, unless he has recorded 
observations to back his statements. Looking back from 
year to year, one finds a long list of certain cures, which 
he has tried and dropped, till near the close of a long 
and successful practice, a friend who formerly occupied 
the chair of Theory and Practice, said to me at a consul- 
tation, " Doctor, I have about come to the conclusion that 
in acute diseases, medicines are of comparatively little 
value ; but in chronic cases, I think minute doses of bi- 
chloride of mercury are sometimes useful." The statement 
was a strange one, but it contained a marvelous amount 
of truth. Dr. Ware's observations were of value to all 
who knew him, for they were known to be faithful, and 
his statements were cautious, and we know he believed 
them. 
You will try the new cures as they come up, and will 19 
be astonished, that your older brothers do not believe you 
will see such results as some one's treatise convinces you 
must come. But if at the end of a quarter of a century's 
practice you obtain more than one new medicine upon 
which you can rely, and do not forget a hundred new 
ones which you followed the fashion in, it will be because 
the progress of the future will far exceed the progress of 
the past. 
From mere fashions in medicine keep yourselves aloof. 
Keep your observing powers awake, and pick up every 
crumb of knowledge which falls in your way. Do not yield 
your faith to what is said to be true, but constantly doubt. 
One successful result proves nothing, and a hundred will 
not prove all. Let go all anxiety lest your patient should 
discharge you, because you do not believe in the course 
which the patient's friends may dictate. Whatsoever 
course your observation leads you to believe, follow out, 
but be sure your observation is correct; and if pretenders 
seem to succeed the most rapidly, you will find that they 
also succeed each other. The tide is constantly changing; 
and if those who leave you for the charlatan do not re- 
turn to you, it is from shame. After they have been 
the rounds of quackery, the majority of them will fall into 
the hands of other regular practitioners, while their pa- 
tients will go through the same course, and fall into yours. 
See how the water fashions change. Those gentlemen 
are here, who remember that a drop of cold water was 
supposed to be certain death for the patient, whether used 
without or within. The day came when it was poured in 
without stint. Most of us can remember when at every 
furniture shop stood the everlasting cotton covered closet, 
which was also to be found in almost every bedroom, and 
into which every man who desired to preserve his health 20 
was expected to walk every morning, and take the cold 
shower, on rising from a warm bed. He was hardly deemed 
fit for society who did not perform his daily devotions 
with cold water at the shrines of rheumatism, pneumonia 
and pericarditis. Some were doubtless benefitted by wash- 
ing, and some who were not, escaped ; but like the Spartan 
children, who lived through the exposure, it was because 
they were tough. 
The fashion changed because it was so uncomfortable, 
and men kept clean comfortably, and the bills of mortality 
did not increase as the sale of the shower bath diminished. 
The water fashion has returned, but in a new form. 
By many it is known that the Turkish process of par- 
boiling and scraping off the epidermis, and sending you 
from a temperature of 120° to 32°, or 0°, is sure to cure 
disease and promote health. But there are those of us 
who are trying to gather courage to think that we have 
seen pernicious effects follow, and we do not choose to 
recommend for every one in this climate what may answer 
very well at Constantinople, especially as our Turks omit 
the one saving element of the service-the greasing after 
the bath, as a partial means of replacing the epidermis. 
And mineral waters are in fashion, and Missisquoi and 
Gettysburg and Sheldon and Saratoga and Sharon vie 
with each other, till each of them cures in a year more 
cancers than the country can show, while hospital records 
will show you that the number which come under the 
knife of the operating surgeon does not diminish. As an 
observing physician reads the account of the symptoms 
and the progress of the cures, he recognizes the effects of 
nature's purely vegetable remedies, in which he has some- 
times found iodine and mercurials, and in place of cancer 
he reads-Pox, 21 
Thirty years ago they were rash physicians who had 
not joined in the crusade against alcohol. It had been 
used by them, but time and reflection, not recorded ob- 
servation, had satisfied them that it never aided in cure, 
but was the parent of almost every disease. The docu- 
ment still exists, upon which honored names attest the 
truth of this statement. But fusel oil was supposed by 
some one to prevent phthisis in Copenhagen, or some- 
where else, and the same doctor who knew that alcohol 
caused phthisis, has adopted the fashion of putting the 
whiskey bottle on every consumptive's table. The obser- 
vations are yet to be made, which will prove to the pro- 
fession that alcohol is sometimes the cause, and sometimes 
the cure of phthisis, and he who investigates, if he wishes 
to have his word of permanent authority, has got some 
other table to arrange than that which shows the amount 
of whiskey taken, and the hours of taking it. It must 
show the other articles of diet, the nature of the soil, the 
surroundings of the habitation, the chimneys, the cast iron 
stoves, and forty other things which perhaps none of us 
have yet the remotest dream of. 
And what has become of the lancet ? The time has 
been when a dozen lancets a year was only a fair allow- 
ance in a large practice. I believe it is true that there 
are twenty physicians to-day who never bled a patient for 
every patient who is bled. 
In one institution in this city granular disease of the 
conjunctiva was for years more common than healthy eyes. 
There were two collyria used, a weak and a strong. 
The one contained sixty, the other one hundred and 
twenty grains of nitrate of silver to the ounce of water. 
They were applied faithfully and in good faith. It was 
the fashion introduced by some one's treatise; but the 22 
observation of others showed that they made more disease 
than they cured, and the more moderate treatment of 
this day introduced here by one of our friends, was fol- 
lowed by the relief of nineteen-twentieths of the patients in 
a few weeks. 
At that time it was believed that mercurials alone could 
prevent the loss of sight by iritis ; but in later days we 
have seen the disease melt away without them as the 
fashion has changed, and observation has shown that 
theories which were in vogue were false. 
Mercurials were known to increase the secretion of bile, 
and blue pill and calomel were, and still are with some, 
as common as their daily bread. Dr. Bennett of Edin- 
burgh, however, chairman of a committee of the British 
Association, has lately made a report of observations upon 
the subject, a report made with great care of experiments 
upon dogs, which shows satisfactorily, that in that animal, 
at least, the effect of mercurials is to diminish the amount 
of bile secreted. Upon this subject you will undoubtedly 
hear more before this winter's term is completed. Observ- 
ation has yet to show if podophylin or leptandrin can 
take the vacated chair, or whether anything can do it, or 
whether it be of much use to stir up the sluggish dignity 
of an unwilling liver. 
Antimony, ad nauseam, was the only article which could 
relieve pneumonia, but we see patients recover now, who 
get well of pneumonia with no medicine, except an 
opiate to relieve their pain, and even without that. 
If so much turns out as represented, you may ask, 
what are we to study medicine for? Why to continue 
the improvements in practice. To do your part in pre- 
venting sickness, in alleviating suffering, in extending the 
term of life. Medicines have their uses, as well as their 23 
abuses. You are to learn how to give them, and when 
to give them. More, you are to learn when not to give 
them. The inert pill or the perfumed water, as well as 
the active cathartic and the opiate, may sometimes be of 
service to your patient, to prevent his taking medicine 
which will aggravate his disease. That is medical treat- 
ment sometimes of the most useful kind; for many men 
will take injuriously active medicine if you do not give 
that which is innocently inactive. It is for you to study 
your patient, and learn whether he will bear to be told 
the whole truth, or silence best; whether he needs rest, 
or change of food, or change of habitation, or the admin- 
istration of drugs. It is for you to find out, and it may 
take years to find out, whether it will be best to let blood; 
for the day may come, if .you do not learn how, when some 
unfortunate will die of suffocation at the beginning of 
pneumonia, when the loss of a few ounces of blood would 
save his life. It is for you to find out when one's rec- 
tum is impacted with foeces, of if his small intestine is 
strangulated, and whether the cathartic, the syringe or 
the knife, will relieve him. It is for you to find out if 
it is a foreign body in the aesophagus or sedema of the 
glottis that obstructs his respiration, and to decide be- 
tween the probang and the bistoury. It is for you to 
find out whether he has spermatorrhoea or a deposit of oxa- 
late of lime in his urine, and whether he is to be relieved 
by medicine or surgery, by hygiene or chemistry, by a 
moral lecture, or the last funny book. 
Make your study by observation. Following the rules 
of one writer, studying by the bedsides of one practition- 
er, will only be enough to narrow your ideas, and cramp 
your progress. The sick recover with very different 
methods of treatment. You will learn more thoroughly 24 
by confining your observations to a single class of cases 
at-a time, and by following the clinical visits of different 
physicians at the same time. You will obtain more useful 
knowledge by seeing the minor operations in surgery and 
the applications of splints, than by crowding the amphi- 
theatre to see the abdominal aorta tied. You will serve 
your patient better, if you can learn how to lift a lame 
leg, or compress the femoral artery, to reduce a hernia or 
get a grain of sand out of the eye, or teach some nurse how 
to make a palatable gruel or a comfortable bed, than you 
will by naming accurately the ligaments of the cervical 
vertebras, or counting and demonstrating the number of 
layers of fascia over a forty years' inguinal hernia. The 
little things are to be learned at the beginning, or they 
never will be learned. In the long days and evenings 
after the degree is attained, you will find time" enough 
for the rest. 
You will do bettei' to keep full records of a certain 
number of cases, which you may see, than to write notes 
of the lectures you attend. By that course you will ac- 
cumulate facts which in after years can be compared with 
facts in your practice, and which, if properly studied, will 
be of infinitely more service than records of opinions. 
You will learn to observe the surroundings of patients. 
You will learn hygienic laws. You will learn how men 
die in spite of drugs, and get well in spite of drugs. If 
I do not greatly mistake, you will learn that some r ay 
have died who might have lived, if something had not 
escaped your early observation ; and that some lived v ho 
would have died, if as students you had not obse. -ed 
some new fact to which your predecessors were blind