LECTURE INTRODUCTORY TO THE COURSE v Ulaima: gMint anfr §tnxnl Cjjtrajjntlits, JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA, Delivered October 13th, 1857, , THOMAS D. MITCHELL. Pufttfeljet) iig tfje Class. PHILADELPHIA: JOSEPH M. WILSON, No. ill SOUTH TENTH STREET, BELOW CHESTNUT. 1857. V s ; :• V* r CORRESPONDENCE. Si&ersan iHrtt'cal College. Philadelphia, October 27th, 1857. Prof. Thomas D. Mitchell, Dear Sir:—At a meeting of the Students of Jefferson Medical College, held on the 19th of October, D. Kindleberger, of Ohio, was chosen President, and E. B. P. Kelly, M. D., of Pennsylvania, Secretary. On motion of J. C. Bertolette, of Pennsylvania, it was voted unanimously that a special Committee of five be appointed to wait on Prof. T. D. Mitchell, and request of him a copy of his Inaugural Address for publication. The following gentlemen were appointed as that Committee: Chairman,— NAHUM M. TRIBOU, Jr.............United States, THOMAS BOWERS....................Canada West, HENRY KIRKWOOD,..................Nova Scotia, FRANCIS E. BOND.....................South America, JOHN G. KERR..........................China. It was also voted, that a Committee consisting of the first Matriculate from each State and County, represented in the College, be appointed for the pur- pose of superintending the publication of said Address. The following gentlemen were named: CHAIRMAN. GEORGE W. SNOW, Massachusetts. MEMBERS. G. P. Townsend,...............Maine. T. S. Bradford,...... ........R. I. Judson B. Andrews,.........Conn. Samuel D. Flagg, Jr.........N. Y. J. Langendorfer,.............N. J. Wm. M. King,...................Penna. Samuel D. Marshall.........Del. J. H. Taylor,...................Md. M. F. Hullihen,..............Va. John D. Spicer,........ .......N. C. Sampson Pope,..................S. C. John S. Coleman, M. D......Ga. J. W. Little,....................Florida Wm. M. Bryant,...............Ala. Charles G. Smither..........Miss. The Secretary was instructed to furnish a copy of the Minutes of this meet- ing, to be presented by the Chairman of the special Committee, to Prof. Mit- chell. DAVID KINDLEBERGER, President. EDWARD B. P. KELLY, M. D., Secretary. Jefferson Medical College, October 29th, 1857. Gentlemen: Your note of the 27th inst., is before me. Allow me to say, that imper- fect as my Introductory Lecture is, it is entirely at your disposal, and the more especially so, if its publication can in any way advance the welfare of the Col- lege. Have the goodness to assure the gentlemen whom you have the honour to represent, of my hearty good will to co-operate with them in every laudable effort to further their welfare and yours, as well as to elevate the noble science in whose cause you have enlisted for life. With high considerations of respect for the class individually and collectively, I am, Gentlemen, very truly, your friend, &c. &c. Thos. D. Mitchell. To Messrs. Tribou, Jr., Bowers, Kirkwood, Bond and Kerr, Committee. Thomas J. Vance,__ Le Grand G. Capers, J. D. Grafton,......... J. Monroe Moodie,.. James Allison,......... W. T. Sharp,........... John B. Weaver,..... C Madison,............. 0. G. Potts, M. D..... John P. Thatcher,... Rowley Morris, M. D. Thomas Bowers,........ Henry Kirkwood,...... Francis E. Bond,........ John G. Kerr,........... La. .Texas. -« .Ark. ..Tenn. .Kentucky. .Ohio. ..Indiana. ..111. ..Iowa; ..Mo. ..AVis. ..Ca. West. v ..N. Scotia. ..S. A. ...China. INTRODUCTORY LECTURE. Gentlemen :— On my first appearance in the halls of this time- honoured Institution, in the capacity of a public teacher, some of the vast assemblage of intelligence and learning now before me, may have anticipated a programme, at least, of the task to which the honourable Board of Trustees has been pleased to call me. It has been judged a wiser course, simply to tender to the medical class and to the entire profession here congregated, a solemn and honest pledge, to devote all the energies of my physical and mental constitution to the high behests of this venerated spot; to advance the real welfare of all who may honour me with their presence, and to aim, if possible, to enhance the fame of this proud hall of science. That pledge is now tendered, under a deep sense of the high responsibilities which cluster around me. Of the multiplied sources of human happiness, kindly provided by the munificence of Deity, none is more exuberant or gratifying than Contrast. To be compelled to gaze, incessantly, on the unblended beau- ties of nature or art, would be to sicken us with delights; while the perpetual grating on the ear, of the groans of the dying, and the terrible convulsions of nature, as they are developed in earthquake and tornado, would engulf us in wretchedness, too intolerable for endu- rance. We live and move under the persistent influence 6 of contrast, nor could we be happy in this transitory state under different circumstances. What, I ask, induces so many young gentlemen to forsake their happy homes and pleasant companions, for months, and to commingle with strangers in a far off land ? Could this sacrifice be tolerated always, and is it not now borne chiefly on ac- count of benefits anticipated as the result of the toil to be encountered ? At this very moment, ere the sentence passes from my lips, you are placing before your vision the termination of your career of pupilage, and your enjoyment of the richest rewards. You feel that you are not to be tyros in the profession always; and with fancy's telescope, some of you even now gaze on the dis- tant day that is to elevate you to the post of teacher in a school of medicine, or perch you on the summit of pro- fessional excellence in your native land; and the con- trast between now and then, as it rises and amplifies its broad dimensions and its unutterable importance, fires you with zeal and nerves you with perseverance. The object of my discourse, Gentlemen, is to sketch as faithfully as I can, in consistence with brevity, The Lights and Shadows of Professional Life. That the discouragements of the dark side of the picture may not s chill your ardor, it will be my aim, so to touch the brighter scenes, as to augment your admiration of the landscape when you gaze upon it as an imperfectly finished whole. Some there are who think of the pro- fession of medicine, only, as a repetition of delights, a succession of enjoyments, but these are dreamers of the night. There are pleasures in all professional pursuits, and none more exhilarating than those that flow from the honest and successful discharge of a physician's duty. But there are vexations of spirit, and there are physical sufferings too, that not unfrequently mar the happiness, that to another's eye, may seem to be pure and peren- nial. Of the varied shadoics that give a sombre hue to the 7 life of a physician, allow me to name, as entitled to a prominent place, the difficulties encountered by many pu- pils in the course of study. These may arise, partly from defects in early education, and in part from want of pecuniary means. Embarrassments, such as these, are always augmented by a consciousness of ignorance, or a sense of humiliating dependence on others, or by both. When, as sometimes happens, a young man of very feeble intellect, and of slender literary acquirements, enters on medical studies, he feels not how deficient he is, and, of course, realizes not the difficulties that are soon to gather around him. Such persons are apt to entertain highly favourable notions of their own powers, and at all events have convinced themselves, by what process I know not, that any sort of material may be worked up into a Doctor, and that, therefore, they need not despair. Others there are, whose native powers are of gigantic proportions, who, though far from having been well educated, have become enamoured of medicine, and are devoted to its study. And, however industrious they may be, they meet with hinderances at almost every turn, and their ardour is often suspended. Such per- sons are sometimes compelled to protract their studies beyond the limit prescribed by their first calculations, by reason of poverty. The man whose means are very limited, although possessed of a high order of mind, is often forced to be in the rear of the drone in science, whose purse, it may be, is far better supplied than his head. This may be a source of keen mortification, for which there can be no remedy but patience and perse- verance. But, the medical student who is endowed with a mind susceptible of high improvement, albeit his early education may have been sadly neglected, may realize abundant satisfaction even in the midst of the perplexi- ties that beset him. Conscious of deficiencies, but re- 8 solved to master them all, he is sure to make headway; and so the acquisitions of to-day are mingled with gra- tification that far outweighs the despondency associated with the defects of yesterday. He feels the true value of what is gained, because he knows what it cost him. Such men there are, such have always been, and will be, to the end of time. The difficulties of early life were blessings in disguise, fitting them the better to meet the trials of professional life, and to honour it by devotion to its highest interests. Omnia vincit labor was their motto in the midst of discouragement, and it gave them the victory. But it has happened, alas, how often! that pecuniary wants have embarrassed the medical studies of young men, whose native talent and educational advantages were of a superior grade. Eager to advance as rapidly, at least, as any others, their laudable zeal has been checked by the iron force of dire necessity. After a patient attendance on one course of lectures, their stu- dies have been intermitted for one, two, or three years, by the laborious toils of the schoolmaster, in order to eke out funds enough to complete their medical course. In such a painful interval, their acquired stock of know- ledge is, at best, in statu quo, and all that has been learned must be studied over again. To him whose ambition is restive under such restraint, as the war- horse under the iron bit, this kind of drawback on fu- ture prospects, is a source of unspeakable mortification. He cannot, or does not, realize that all this is for the best, and that the perplexing delay is, probably, to be the very means to secure a more certain and honour- able advancement. Unhappily, with the bias too com- mon to youth, he looks at the present only, and his heart sinks within him, and he is almost driven to a perpetual abandonment of a pursuit that is dear to his heart. His spirit falters and hesitates, and he mourns in secret places over the haplessness of his des- 9 tiny. Young man, if the portrait just sketched at a venture, be a picture of your own case, do not despond. Cheer up, toil on, for better days are coming. It may be the good fortune of the pupil to escape all the quicksands and shoals at which we have hinted, and yet he may realize unutterable anxiety ere he make his actual debut on the theatre of professional life. Some men, encumbered, doubtless, with a morbid sensi- bility, have been wrought up by their imaginative powers to such a state as to be actually miserable, in the pros- pect of the green-box trial, just at hand. And it is quite possible that some, now before me, entertain a very alarming apprehension of the reality of that untried ordeal. This weakness, for such it often is undoubtedly, although witnessed, occasionally, in the most talented members of a class, suffices to give pain and disquiet to the subject of it. One of the best qua- lified young men I ever examined, now at the head of his profession in the place of his abode, was so deeply distressed from this cause, that he burst into tears the moment he was ushered before the faculty, and was un- able, for several minutes, to command his feelings. It is a very common sentiment, that no trials can be more painful than those of a candidate under examination; and hence the erroneous conclusion, that the procure- ment of a diploma, is the most difficult item in his whole career, the ultima thule of his life. But alas, the reverie is of brief duration. The man awakes from his dream, and new difficulties meet him on every side. This leads us to present, as another of the shadows of professional life, some of the obstructions in the icay of obtaining business. There are those into whose lap, fortune, or Provi- dence, rather, has showered an abundance of this world's goods, and who are thus saved from many of the trials that befall the more indigent. I do not affirm that this seeming advantage is, in reality, upon the whole, very 10 desirable. If it prove a source of blessing to some, most assuredly it does not always so operate. For the most part, however, young graduates are in straitened cir- cumstances, and need patronage quite as fast as it comes. Not unfrequently, too, they commit the sad .mistake of forming an acquaintance that is too exten- sive and too fashionable for their best interests. They are thence led to acquire extravagant notions of dress and living, and to study less, and to be more frequently absent from their offices on calls of politeness, than propriety warrants. These habits are very likely to acquire strength faster than the subject of them is aware, while they are closely watched by the discern- ing and prudent around them. Instead of living with- in their resources, the discovery is soon made that they are in debt; and the next step is to change location, or, possibly, that is anticipated, by the seizure of books and instruments, to satisfy the claims of impatient cre- ditors. Many a young man, however, who has been very pru- dent in his associations and expenditures, has experi- enced embarrassments, and realized painful emotions, in his efforts to obtain a livelihood by his profession. A ' regard to the usages of the place compels him to pre- sent a good exterior, a result not equally well secured by all, even with the same amount of means. Some will appear genteel and neat at all times, at a cost that would but little improve the person of another. Be- sides all this, it is desirable to have the reputation of boarding at a good and respectable establishment, since even this may influence success in no small degree. But it has happened, that young physicians have not been able to make regular provision for boarding any- where, and although quite neat and fashionable in their attire, have been compelled, sometimes, at least, to sponge, (as the word is,) on this, and the other ac- quaintance, and to get additional meals, just as cash 11 was on hand, or, to fast. You have no need, gentlemen, to travel over the Diary of an English Physician, for facts in point. I tell you, that one of the most eminent medical professors in America, one, who in the estima- tion of hundreds, was first on our roll of fame, was, for years after graduation, unable to be a regular inmate of any boarding-house. His acknowledged talents and indomitable ambition kept him afloat in the ocean of difficulty, that has engulfed many of feebler intellect and nerve, until the way for promotion was thrown open, and the crown of honourable distinction placed on his head. He has left his laurels behind him, won amidst toil and privation, that you may not be discou- raged when you remember, that although long beset with difficulties, he rose above them all, and mounted the hill-top of professional glory. Go ye, and do like- wise. If the hints just thrown out, meet the special trials of any young physicians who are yet in a state of single blessedness, with what force do they press upon those, who, destitute of the funds called for by such a change, have unwittingly encircled themselves with the chain of matrimony. The sad result often proves to be, that two, in place of one, are made unhappy, and the mis- taken man, at his leisure, is compelled to repent the folly that has brought so much sadness to another, who fondly hoped for better days and more cheering scenes. Well aware am I, that young doctors have sometimes extended their business considerably, by a judicious nuptial enterprise; but such cases are so few and far between, that they rather serve as monitors to curb the impetuosity of youth, than prompt, at all hazards, to make the venturous leap in the dark. It is as true, no doubt, now, as it ever was, that "it is not good for man to be alone," and I think it vastly important, for the physician to have an affectionate, wise, and prudent helpmate, nor could I bestow upon any pupil before 12 me, at the right time, if it were in my power, a richer earthly boon. But if any act in a young physician's history, imperiously calls for prudence and discretion, it is that, which of all others, most tenderly and deeply implicates his own happiness, and not less, hers, whose fortune he proposes to link with his own. It is quite possible that some who hear me are des- tined to locate in regions not yet under the full influ- ence of civilization, and that they may realize hardships more appalling than any yet adverted to. Though in little danger of the red man's violence, your lot may be cast in a new country, where it may be very difficult to compass more than sufficient to meet the actual wants of life. A physician, born and educated in Paris, bade adieu to the comforts and refinements of his beau- tiful home, to pitch his tent on the banks of the Ohio river, not far from Marietta, some forty-five or fifty years ago. The country was in the wild state, empha- tically, and destitute of roads. Too poor to purchase a horse, the Doctor, blest as he was with a buoyant and indomitable spirit, attended to a large business on foot, making journeys of ten or fifteen miles with as much rapidity as is usual on horseback, in rugged re- gions. This hard service was performed nearly two years, ere he was able to own a horse. He had a small family to care for, and it was his pleasure to toil for their comfort. Some will be ready to exclaim, " Contemptible servitude!" " Wretched occupation! " But says the venerable Hildreth of Marietta, " I have often heard this man say, in after and more prosperous days, that he looked back to the period referred to, as one of the happiest portions of his life." That this in- telligent, popular, and successful practitioner, as the narrator styles him, felt the long period of his poverty to be a season of trial, none can doubt. But that the discipline thus had in the school of adversity and toil, laid the foundation of subsequent distinction, is equally 13 obvious; and the brief story is pregnant with valuable instruction to every student of medicine. Think you that such a man, even though pressed on every side by the force of untoward circumstances, could falter or retreat? Never, never. His banner, floating proudly in the breeze, was stamped in letters of living light, with victory. " The proudest motto for the young! Write it in lines of gold Upon thy heart, and in thy mind The stirring words enfold; And in misfortune's dreary hour, Or in the prosp'rous gale, 'Twill have a holy cheering power— 'There's no such word as fail.'" What if adverse winds assail you? Are you the first that has felt the peltings of the storm? Why then despond? Dr. Johnson remarked that a habit of looking at the best side of every event, is worth more than a thousand pounds a year. It was a quaint saying of Bishop Hall, that for every bad there might be a worse, and that when a man breaks his leg, he should be very thankful it was not his neck. In the same spirit was Fenelon's exclamation, when his precious library was on fire; "God be praised," said he, "that it is not the dwelling of some poor man." That was the soul of true submission, one of the most splendid jewels of the human heart. Gaze on the world you must, but have a care to look most at its sunny side, and half the battle of life will have been won at the outset. "A smile on the face, and soft words on the tongue, Will serve you as passports all nations among; A heart ever cheerful, a spirit that's free, Will carry you safely o'er life's stormy sea." If the sailing of a wind-cloud hath Providence for its Pilot, your bark is secure with the same guardianship. Allow me to notice, as another of the shadows or 14 trials of professional life, unkind treatment from other physicians, and also from patients. Sincerely do I regret that there has ever existed such a state of things as to justify the remarks about to be made. But, alas! it seems that Doctors, with all their advantages, are des- tined to continue to be as they have ever been—men of like passions with Adam's entire posterity. Hence the proverb, too often well founded, that if three or more physicians reside in the same village, there will be strife between at least two of them. The proneness to do injustice to professional brethren has its origin, not unfrequently, in a deep-wrought con- sciousness of their high superiority. The envious man cannot endure the prosperity of his neighbour, for self- ishness is the main spring of all he says or does. Is the success of another lauded over the vicinity, and does his business expand, on this account? Envy is supplied with new aliment, and its machinations are multiplied in order to effect the downfall of him at whose head its venomed shafts are aimed. Truth is distorted, until it bears the impress of falsehood; and fictions, artfully concocted, are sent broad-cast over the community, as if they were realities. One of the most reprehensible arts practised in our profession, is the unmanly trick of entering, under cover of night, or with false pretences in broad daylight, the chamber of a patient under the care of another physi- cian. By an artful misnomer, he converts his officious- ness into a visit of friendship. Having learned that his good neighbour was sick and low-spirited, he comes to cheer him up, and while away a tedious hour. Such is the profession he makes, but note his cunning. He draws from the patient what suits his purpose; and by significant shrugs and sighs, and half-uttered sentences, actually trenches on the confidence reposed in the me- dical attendant, until the sick man begins to doubt whether his Doctor understands the nature of the case. 15 These kind and friendly visits are reiterated until the intruder fancies he has a claim on the patient, and actually succeeds in supplanting the object of his envy. These, and many other stratagems alike derogatory and mean, are perpetually in operation, and serve to explain, very satisfactorily, the want of friendly feeling and harmony, that salutes our ears from every quarter. And in adducing some of them, to illustrate what I mean by the shadows of a medical life, do not imagine that I suppose the victims of such base devices are the only sufferers. That their spirits are often wounded to the point of taking an everlasting leave of the profes- sion, is by no means an unfrequent result. But, could you read the dark lines, drawn deep as with the dia- mond, on the accusing conscience of the man who thus sports with the sensibilities, the character, the happiness of his brethren, you would discover the hidden but no less real truth, " That he who gives a pang, himself ten pangs receives." The soul that is hardened till it feels as little as the millstone, will have (for Heaven has so decreed) mo- ments of self-torture and biting stings of remorse, keen enough to cause the miserable being to hate him- self, and wish that he had never gazed upon the light of day. Ah! he, too, shall know and feel the sorrows of a medical life, and shall realize that the bitterest ingredient is the fact that they are self-inflicted. The unkindness of patients to their physicians is also a fruitful source of distress and embarrassment, and sometimes has a poignancy blended with it that can scarcely be tolerated. You may comprehend my meaning when you hear an illustrious physician of America exclaim, "Oh, the ingratitude of man! He sank by misfortune from affluence to poverty, and I waited on his family in the years of their destitution, by night and by day. I sympathized with their sorrow- 16 stricken spirits, and poured, as I could, the oil of con- solation into their bleeding hearts. My purse was ever open to assuage the anguish of their troubled hearts, and I was ready to make almost any sacrifice for their good. I knew that they could not recompense me, but I felt the unspeakable pleasure of befriending the for- lorn. But, judge of my astonishment, when, as if by magic, on a sudden turn of fortune's wheel, this very family rose again to affluence and splendour, and more bloated with pride than in the days of their original grandeur, they shunned the physician who had been a benefactor in the time of need, lest his presence in their gilded halls should call up, unseasonably, the remem- brance of the scenes of penury through which they had so lately passed, cheered by the purest friendship, for which the only return was base ingratitude." But physicians sometimes realize deep distress in consequence of the deportment of families whose cir- cumstances have always been good, and to whom the most faithful services have been rendered; and this, too, without any sort of apology being offered, or an oppor- tunity given for explanation. This wanton trifling with physicians seems to arise from a capricious recklessness, which eludes, because it cannot bear, a free scrutiny. Sometimes it is developed by the presentation of a j ust account, already too long neglected, and which, instead of being thus met, should have been promptly discharged at the first solicitation. If there be real or imaginary cause of complaint, candour and justice demand that the difficulty be stated frankly and fully. The physi- cian may be able, by a single sentence, perhaps, to re- move every particle of misapprehension; and he will rejoice to do so, if his demeanour be correct. If, instead of pursuing this fair and honourable course, another medical adviser be sent for at the next illness in the family, a positive wrong is perpetrated; a wound is inflicted without due cause. 17 Having hinted at the modus operandi of a Doctor's bill in certain cases, it may be proper to extend our views a little further. And here let me say, that phy- sicians experience not a little perplexity from their patrons, as the result of the too general indifference respecting compensation for services rendered. At the moment when danger appears to be very great, some persons seem to value our services above all price, whose memories fail surprisingly when the urgency of the case has passed away. The candidate for medical honours and for medical practice may calculate on being roused from his slumbers with much greater violence and im- portunity, and more impatient haste, by one who never pays a Doctor, and, it may be, never thanked one for services rendered, than by him who is not only willing but anxious to reward his toil. When I have been called to the chamber window by the thundering peals at my knocker and the kicks at my door, in a dark and stormy night, when the elements seemed as if they had waged war with each other, and as though heaven and earth were about to come into collision, and a strange voice has proffered to give " any sum of money for a Doctor," although I may not have refused to go, I have always made my calculations to draw a blank in a lot- tery whose tickets I felt to be noisy promises only. Indeed, to decline a call of this kind, would most pro- bably excite the clamours of many who never paid a physician's bill, apart from the operation of the law. And here, gentlemen, let me advise you to appreciate your rights. Some men will treat your call for pay- ment as if it were a favour to pay. Let them under- stand that the favour lies on the other side, for some are actually ignorant on this point. There are occa- sions, moreover, in which the physician renders services that money cannot fully compensate. He fixes a nomi- nal value, to be sure, but that rarely meets the case; and if kindness and good feeling do not make up the 2 18 deficit, he is not requited as he should be. I am proud to say, however, that now and then the balance is fully realized in a sense of gratitude and confidence, that grows with years and strengthens with time, and is a prouder monument than was ever erected for the blood-stained hero. But, the physician often experiences mental suffering from the sad consciousness of the imperfections of the science, or of his failure to give its principles a right application. The most successful practitioner is not entirely exempt from seasons of disappointment. Some unseen power working in the atmosphere or elsewhere, conspires, with more obvious causes, to augment the violence and ob- scurity of the morbid phenomena with which it is his province to contend. He calls to his aid the experience of bygone years, and searches the records of modern times, to find, if possible, the secret of his present em- barrassment. His patients fall on the right hand and on the left, with symptoms not unlike those which have been subdued a hundred times, with ordinary efforts. Presently, he is at the couch of one whose life is of un- speakable importance to his family, to numerous friends, to the church, to the country, to the world. The anxious settled gaze of relative and associate, as if re- solved to drag from the bosom of the physician his private opinion of the probable issue, meets him on every side. He presses the resources of his art to the utmost stretch of ingenuity, but a secret conviction that all is in vain, mingles with every movement. Respon- sibility may be divided, it is true; and the ablest con- sulting aid back his own judgment; but, alas! the heavy load rests on him. He may have made a mis- take at the outset of the attack, for that is possible, of course; for his diagnosis may have been at fault. Ah! who can estimate the unuttered and unutterable sorrow that overpowered the sensitive medical attendants of the immortal Washington in his last brief illness! Who 19 can guess even what are the feelings of the true physi- cian at such a crisis? He may enjoy the unbounded confidence of the patient, and his friends and neighbours may all testify to his fidelity and skill; but he may have a painful misgiving that there has been error some- where, and his soul sighs in secret. He is compelled to witness the failure of his art to rescue from the grave a life of inestimable value, and he mourns in spirit that he ever made physic the profession of his choice. Well, do I know, that a consciousness of rectitude, a deep sense of unflinching integrity of purpose may sus- tain a man amidst the most appalling trials; yea, may steel him against despair, and cause the placid serenity of innocence to play around his brow. And I know, also, that there are stoics in the profession, men of no souls, or with souls little enough to be cramped in a nut-shell, who are reputed to have lost an amount of sensibility which never entered into their composition. But tell me, if you think you can, who in the wide, wide world, educated under the full blaze of Christianity, could have been the medical attendant of the father of his country in his last agony, and in the tremendous trust, felt no sadness of soul, no anguish of spirit, lest some remedy might have been overlooked, whose proper application might have protracted the priceless life of him who was first in peace, first in war, and first in the affections of his countrymen. What reader of the sacred page has not felt the manli- ness of his nature melting almost to tears, on perusing the brief tale of the dead youth " who was the only son of his mother, and she a widow ?" Ah! the sub- limity and the pathos of that inimitable story owe their transcendent beauty and power, to the sentiment of which we have been speaking. It was not merely that the parent was a doting mother, and she in the loneli- ness of widowhood; but it was, that her only son, yea. perchance, her only child, the last earthly prop on which 20 her waning life reposed for comfort, had been hidden from her sight in the darkness of the grave; it was this consideration that moved the compassion of Omnipo- tence, and prompted the display of miraculous power. It is, however, during the ravages of a desolating epidemic that, for the first time, visits our neighbour- hoods, that we realize most acutely the imperfections of medicine, and are grieved beyond expression at the feebleness of our most energetic and best directed efforts. How should these facts inspire the student with new ardour to investigate the deepest recesses of our science, and to comprehend all that can be known, whose ten- dency is to keep at bay the active agents that wage war with human life. If the well instructed physician who has hazarded his own comforts by inhalation of the vapours of the midnight lamp, may be called to ex- perience mental distress because of the inefficacious ap- plication of the principles of medical philosophy, what may he not expect who wastes the hours and months and years of pupilage in frivolous amusement or wanton dissipation? If, in the course of trifling away precious time, he has succeeded in banishing the last particle of sensibility from his bosom, he may practise physic, and never have his tranquillity ruffled by a single pang. But if a spark of the endearing sympathies of his na- ture remain, his anguish will be the more intense when he reflects on opportunities lost, seasons of instruction misimproved, the proper use of which would have quali- fied him, more perfectly, for professional usefulness. More frequently too than we are aware, are our profes- sional efforts foiled by the cupidity of those who, void of principle and integrity, impose on the unsuspecting practitioner, the most worthless articles of medicine for the genuine coin. Well do I remember how the public distrust was excited in certain regions some years ago, in respect of the powers of the grand heroic for the treatment of periodical fevers. The only manufacturers 21 of sulphate of quinine, then in America, were Messrs. Farr & Kunze, whose small establishment on Callow- hill street, gave to the profession this invaluable drug. It was worth sixteen dollars per ounce, and it so hap- pened, that a knave who was engaged quite largely in the sale of medicines in this city, became possessed of all the stock of the manufacturers. He made the des- perate venture to add an ounce of wheat flour to every ounce of the sulphate, and sold the product for the ve- ritable article, then largely in demand. The result of the fraud was speedily manifest in the complaints from almost every quarter, that the sulphate of quinine was not the thing its ardent admirers had proclaimed it to be, and it required not a little time and persistent effort to put the article in its right position. Not onl}7 were scores of physicians mortified and vexed by this scandalous adulteration, but hundreds of suffering pa- tients were doomed to prolonged distress as a conse- quence. And here you will join me in seconding, as I most cordially do, the fitting remarks of my learned colleague who addressed you last evening, on the natural ten- dency of the progressive character of our science to stimulate your studies, to abate the perils of professional life, and to requite the toils of the faithful and devoted physician. I recur to this point, just now, to say, that the same spirit of progress has most signally character- ized the history of Materia Medica in the city of Phila- delphia, and that it is yet in its onward flight. As evi- dence, it will be alike my pride and pleasure to display before you nearly sixty specimens of the finest products of pharmaceutical art, most of them new to nearly all. who hear me, and fresh from the laboratory of Messrs. Rosengarten & Sons, who have politely furnished them for exhibition to the class of Jefferson Medical Col- lege. On each of these, in its appropriate place, you. 22 will hear more, anon* In the meanwhile, may I not congratulate, not the medical pupils in this hall only, but the entire profession, on the new era of pharma- ceutical achievement at home, which if sustained as it now is, and as it should be, will soon rid us of the vile adulterations of our most potent remedies, and so re- lieve us from the mortification, consequent, in part at least, on the defective quality of our best curative ap- pliances ? It were easy, gentlemen, to swell the catalogue of causes that conspire to give pain to the medical practi- tioner. I might place before you, in melancholy rank and file, the agencies that lurk within him, and whose pestiferous operation curses his blessings. The vices that he, alas! too frequently cherishes, not only stain his reputation in the eye of others, but mar his peace, plant daggers in his soul, blast his hopes for time, and cast a sombre shade over his prospects for eternity. But enough has been exhibited of the sable hues of the picture, and we hasten from the dreary scene, to gladden your vision, for a brief space, with a gaze on the love- lier aspects of the landscape. The practitioner of the healing art is not a stranger to pleasure. His joys are peculiar to his profession, and in many instances, far outweigh and more than compensate for all the trials and anxieties of his voca- tion. There are lights as well as shadows in professional life; spots bright arid beauteous on which the eye may rest with pure delight; many a fertile and gorgeous oasis redolent of sweets that grow no where else. The first of these lights that claims our notice, is The * Since the above was in type, Messrs. Hennel, Stevens & Co., che- mical manufactures, of this city, have also sent several very fine articles, designed for a like use. 23 Study of Medicine. If there be those who have no fondness for the practical duties of our profession, it is rare to come in contact with one who has not realized high gratification in its study. When private reading is duly blended with public instruction, and the dry details of books are inspirited with the clear and ample demonstrations of the professor, the student is not only instructed, but delighted, as he progresses. Hence it is not an unfrequent occurrence, that young gentlemen in affluent circumstances, after having finished a full col- legiate course, devote themselves to medical reading and attendance on medical lectures, and sometimes even seek the Doctorate with no expectation of practising me- dicine. They regard the process, as tending to am- plify accomplishments already in possession, and as well calculated to subserve their interests in after life. They know too, that riches may vanish very suddenly, and should that calamity overtake them, a learned pro- fession will come happily to the rescue. Nor is it at all wonderful, that men of inquisitive mind should feel desirous to explore the secrets of na- ture as they are developed in the various departments of our science. Here is a field of broadest dimensions, sure to yield a plentiful harvest under due culture; a mine, whose true value has never been ascertained; an inexhaustible fountain, ever flowing, ever full. To such of my hearers as have just entered the ves- tibule of medicine, and have been not a little perturbed by the seeming barbarism of its nomenclature, I may affirm with confidence, that this is the most rugged and thorny spot in the road. Especially is this so in re- spect of all who are strangers to the etymology of the terms which owe their significance to a dead language. Having mastered this difficulty, you may calculate on accumulating pleasures as you steadily and perseve- ringly advance. These jargonic terms, once fastened in the storehouse of memory, are sure to remain, be- 24 cause the labour demanded to put them there, is a gua- rantee of perpetuity. It is not unlike the intense affec- tion a man is said to have for a very homely lady, whose excellent qualities have prompted him to take her "for better or worse." Her aspect may have been even repulsive at first, as our nomenclature assuredly is; but the sterling qualities rise vastly above the lack of sym- metry in the features, and if he become sufficiently attached to make her his wife, a great man has told us, that his love will be more ardent and abiding than if she were the prettiest plaything on the face of the earth. But the study of medicine is also a source of pleasure to the indefatigable practitioner, whose experience as- sures him every day, that the science is yet very im- perfect. He devotes many an hour, that others would not scruple to waste in frivolous sports, in efforts to res- cue the art of healing from the charge of uncertainty. It was this spirit that prompted the illustrious Rush to say " that a physician ought to be a student to the end of his life." And it was the same sentiment deeply graven on the heart of the great Sydenham, that gave utterance to that magnanimous declaration, "I had rather be the discoverer of a certain remedy for the most trifling disease, than to amass the largest fortune." Such manifestations of the high gratification associated with and growing out of medical study, are to be found in many of our best works, as your reading has already informed you. And yet, some talk largely of the certainty of medicine, as if every deep mystery had been solved as if every alleged fact had a real existence. I tell you, gentlemen, this fallacy of certainty appertains to the poetry of our science, and has little affinity for its sturdy prose. Though we are not ignorant that some men prac- tise physic, more from necessity than because of love for the occupation, still it is true, that many realize 25 great pleasure, even in the drudgery of their calling. There are heart-cheering lights even here, albeit there are shadows enough all the while. I have known those who affirmed, that they never felt so happy, as when fully occupied with professional duties. This is explicable on various grounds, among which stands prominent, the conceded fact, that a spirit of investi- gation is self-expansive, the surest mental fertilizer known to man, growing by its own inherent elasticity, and realizing new sources of enjoyment in every at- tempt to scan the phenomena of nature, both in health and in disease. Some minds would collapse and sink into comparative nothingness, unless stimulated in- cessantly by new aliment for mental digestion. And such is the nature of disease, that a man accustomed to patient research, will discover something that wears the garb of novelty, go where he may. If he be an independent thinker, untrammelled by the dogmas of the schools, regardless of any man's opinions further than they are coincident with truth, he will examine nature with his own dissecting knife, and scrutinize every morbid phenomenon, just as though he alone were in quest of knowledge. This is the system- levelling spirit that pushes ahead on the boundless railroad of investigation, unchecked by the phantasies of theory and the hair-splitting distinctions of the mere sophist. As evidence of the high gratification derived by many physicians from the practice of medicine, allow me to refer to the fact, that they seldom permit an oppor- tunity to escape of making an autopsic examination, although the task is regarded by some as odious, and hence studiously shunned. It is the fond hope, that some faint glimmering light may dawn upon the ob- scurity of a doubtful case that urges the scalpel as it wends its way through the various tissues. Nor does it matter, for the moment, whether the discovery thus 26 made be real or fictitious, true or false, so far as the pleasure of the student is concerned. The raptures of Broussais were not less transporting at the time when he dreamed that he had immortalized his name by a deathless discovery, from the fact, that subsequent in- vestigation was destined to raze his fabric to the dust. The enthusiasm of Archimedes when he leaped from the bath, naked and frantic, terrifying all who heard the joyous exclamation, " I have found it! I have found it!" would have lost none of its thrilling in- fluence on his own soul, if the doctrine of specific gravity had been blotted from the earth in the next hour. Not a small portion of the pleasures of a medical life, not a few of its cheering lights owe their existence to the tendency of medical studies to expand the mind, to liberalize the general views and thus to fit the in- dividual for greater usefulness. The broad field of in- vestigation thrown open to him who embarks in this enterprise, with a desire to have his mind richly stored, presents a most certain antidote to the narrow and contracted spirit that ought to find its fee simple only in the cloister. Armed with the inductive philosophy as a panoply against the fine-spun mysticisms of the mere theorist, he lays, broad and deep, the foundation of all his acquirements, and is charmed with every thing, which having truth for its basis, is but nature speaking in the works of art. The well-instructed physician is prepared to parti- cipate in all the liberal and useful enterprises in soci- ety, and here, too, he realizes pleasurable emotions. Hence, we learn the reasons that operated to give such prominence, in the benevolent and literary institutions of our great city, to Rush, and Wistar, and Griffitts, and other distinguished physicians. Their interests could not be pent up within the narrow limits of lec- ture halls or private offices. They studied human nature in its widest range, and laid under contribution 27 everything around them, in order to amass the great- est amount of intelligence, and to. diffuse the largest measure of happiness. It has been charged upon our profession, that all its apparently disinterested benevolence flowed from the spirit of avarice; and in proof, our attention has been directed to the very rare instances in which physicians have bequeathed large estates to their families. But I need not detain you, to demonstrate the utter fallacy of the allegation. It will not be denied, that medical men really have some considerable regard for money; and it is conceded that a goodly portion of the sine qua non comes into their possession; yet it is equally certain that they evince a very diminutive share of the cumulative faculty; and hence the proverb, that " Doctors seldom die rich." The plain truth of the matter is, that our profession is not only expected to render a vast amount of gratuitous service to the public, but that its liberality in this respect has been a theme of commendation in all ages. Making due allowance, therefore, for all the selfishness and secret motives of a few who are exceptions to the rule, there are thousands on thousands of self-denying offices performed by physicians, in all parts of the world, prompted by the purest benevolence, and the heart- felt pleasure that requites the truly generous. This is their only pay, and none other is expected. The liberalized physician is no stranger to the unsullied felicity that flows from genuine benevolence. And think you, gentlemen, that in venturing to give even a faint sketch of the lights of a professional life—a meagre inventory of its pleasures—we mean to overlook the pure and exhilarating delight that bursts upon the soul and fills it with ecstasy, when our efforts, blessed by Heaven, restore to friends and family one who is endeared by every tie that binds kindred spirits together? Oh, no! faithless should we 28 prove to truth and to the dignity of our vocation, if this resplendent gem were not permitted to shine out from the mass of crudities in which it lies embedded. Are there not some in my hearing who have already seen the visions of by-gone years rise again to their view, as spirits from the vasty deep, to give life and vigour and form, even to the faint traces of reality to which I have referred, and who can say of a truth, " All which I saw, and part of which I was;" and who feel that the happiness of being instrumental in snatching from the grave one estimable fellow-being, is enough to counterbalance all the sorrows and per- plexities that gather in the revolutions of years. Oh, how richly does the mellow tint of such an illumina- tion compensate for the dark shadows that often ob- * scure the pathway of the faithful disciple of Hippo- crates! Have you never seen the portentous gaze of the affectionate wife, as she beheld, with untold agony, the last gasp of the partner of her bosom, his spirit taking its distant flight, despite the most untiring efforts to save? " Insatiate Archer! Would not one suffice ? " #■ The fearful epidemic strikes again, and yet once more; and the victims are borne in quick succession to the narrow house, till at last, like the forest tree shattered by the fury of the tornado, a solitary branch remains to tell the heart-stricken widow that she has not ceased to be a mother. But even that last branch, the lone hope of her desolate heart, lies prostrate, speechless, almost within the icy embrace of the relentless tyrant that spares not for tears, though they flow like rivers. The frantic stare of the bereft one, darting from the couch of the dying to the countenance of the medical attendant, has an eloquence in it of unutterable im- port. It seems to say, with imploring yet despairing intensity of feeling, to which language cannot give 29 expression, " Oh, spare my only child! save me from going down, solitary and alone, in sorrow to the grave." New vigour is imparted by the silent, yet touching and resistless appeal. The energies of the healing art are taxed afresh; its resources are deve- loped and applied with augmented skill and persistence. The dying man revives; the anxious mother weeps for joy, and cannot find language to pour out the over- flowings of her soul in gratitude to him who has been the honoured instrument in effecting the happy result. Where is the physician, who, at such a juncture, would barter his profession for any occupation below the stars? Where the man, from whose memory the circumstances of such a scene could be effaced, while mind retained its powers; or who would not treasure up its minutest details, and call them from the laby- rinths of the past, to dwell upon the vision with de- light, to the last day of his life? We name but one more item under this division of our discourse, and that is, the high satisfaction atten- dant on successful efforts to elevate the medical character. Alas! there are dark shadows enough, and by far too many, appertaining to professional standing; and it becomes us all, teachers and pupils, to do what we can, in the best way, to efface the stain. Every well- educated, honourable practitioner is grieved at the defects so long tolerated in the matter of the prepara- tory instruction of candidates. He sickens at the recklessness with which some are encouraged to shel- ter themselves under the broad wing'of our art, as if it were meant by Heaven to be a house of refuge for the halt, the lame, the blind, of all occupations under the sun. But he rejoices that not a few worthies, ay, that many are added to the roll, from time to time, who have made their foundation sure, and have erected a superstructure that will do honour to their alma mater, and he hails them with joy, as co-workers in the noble effort to redeem the profession from the 30 degradation with which ignorance and charlatanism would cover it. It affords him unspeakable happi- ness to take by the hand every such youthful candi- date for business and for fame, and to cheer him by his counsel, his friendship, and his influence. He has not forgotten the perils of his own opening career, and he knows by experience the value of a medical friend and adviser, at such a crisis. Is the reputation of a brother practitioner defamed without cause ? he will not be a silent witness of the wrong, but, feeling for the injured as he ought to feel, will boldly defend him. He rejoices to rescue from unmerited odium, the humblest member of the pro- fession, assured that the disgrace of one is, in some measure, the degradation of the entire fraternity. And while he pays a reasonable deference to the dis- tinctions that unavoidably obtain, as the result of contingencies, he delights in selecting those for his chief companions, who, to their love of science and re- gard for the honour of their profession, add the charms of a virtuous and consistent life. He feels the resist- less force of affinity for kindred spirits, for those who are identified in their sympathies with the great inte- rests of humanity; and he prefers to rally under the out-spread banner of the public good, rather than to have a signal place beneath the narrow flag of party. With Sydenham, he embraces the whole family of man, in the grasp of his benevolence, and is proud to be one of a fraternity, whose province it is, " to soothe the troubled spirit and give the sufferer rest." Such, young gentlemen, are some of the lights and shadows of a medical life. I would that a mas- ter pencil had sketched the scenes, and made the canvass speak with all the pathos of living reality. Imperfect as it is, the picture is yours, for future meditation and improvement. May it be your happy lot to reap rich harvests of pleasure, not only in the 31 practice of the profession in after years, but in its study, now. To this end make it your business to place a due estimate upon present advantages. Some take no note of time, but by its loss. Be it your ambition to count every moment lost, that is not im- proved. Let each setting sun bear witness to the fidelity of your studies, and you will never regret that you came hither, even at the sacrifice for a season, of all the sweets of the domestic circle, to enjoy the solid pleasures that flow from this fountain of medical science. *»« \