n \:j;cJ fr AN INTRODUCTORY LECTURE BEFORE THE MEDICAL CLASS OF 1857-8 HARVARD UNIVERSITY. BY \ GEORGE C. SHATTUCK, M.D. PKJFESSOU Of CLINICAL MLDICINE. '7 BOSTON: PRINTED BY DAVID CLAPP, Over 184 Washington Street. 1857. AN INTRODUCTORY LECTURE BEFORE THE MEDICAL CLASS OF 1857-8 OF HARVARD UNIVERSITY. BY GEORGE C. SIIATTUCK, M.D. PROFESSOR OP CLINICAL MEDICINE. > U7SH BOSTON: PRINTED BY DAVID CLAPP, Over 184 Washington Street. 1857. Boston, November 16, 1857. Prof. Shattuck — Dear Sir : As a Committee of the Medical Class, we take great pleasure i n requesting a copy of your Address for publication. We are, Sir, Your Obedient Servants, R. J. PLUMER GOODWIN, CHAS. FRED. CREHORE, J. THEO. HEARD. Cambridge, November 19, 1857. Gentlemen : , Agreeably to your request^! send the Introductory lecture to be printed. I regret that the matters therein brought before you are not set forth as fully, as forcibly and as worthily as they should be ; but I hope that, by a hearty good will and a zealous coope- ration, we may do something, during the season now opening, to advance the cause of sound medical education. Yours truly, GEO. 0. SHATTUCK. Messrs. R. J. Plumeb Goodwin, Chas. Fred. Crehore, J. Thbo. Heard. ADDRESS. Mr. President and Gentlemen: The matter for which we come together to-day, is of interest for all classes of the community. Young and old, rich and poor, all are liable to disease and injury; which, too, may come suddenly and with- out warning. It is then the interest of all that pro- per provision be made for the exercise of the art of healing, and that there should be ready, well-educat- ed and thoroughly trained practitioners. The great interest taken in education in our day, is very mani- fest. One of the earliest objects with the first set- tlers of the country was to provide for education. On the 8th September, 1636, the legislature of the Colony of Massachusetts Bay passed an act which resulted in the foundation of Harvard College — a leading object being to provide a well-trained and learned clergy. We say that professional education, then, was in the minds of the founders. No medical school was established till the year 1782. Dr. Her- sey had died in 1770, and had bequeathed one thou- sand pounds lawful money to the President and Fel- 4 lows of Harvard College, the interest thereof to be by them appropriated towards the support of a Pro- fessor of Anatomy and Physic, and for that use only. Dr. Warren was chosen Professor of Anatomy and Surgery, and Dr. Waterhouse of Theory and Prac- tice of Physic; and they were installed in their re- spective offices in the year 17S2. A professor cf chemistry was chosen in the following year, but there was no established fund for his support till the year 1791. Nearly one hundred and fifty years elapsed after the foundation of the college, before anything was done for medical education, and the impulse then came in the shape of a legacy from a medical man. And we cannot but remark in our day, that whilst educa- tion in general is so highly thought of, whilst its importance is so universally admitted, the same unanimity of opinion and interest does not prevail as to professional education. Professional men do not stand as high in the community, do not exercise so much influence, as at the period of the foundation of our college. The matters intrusted to the three professions are of such intimate concern to all, that there is a jealousy in giving them over to a distinct body of men. We all have our own views of theo- logy and jurisprudence ; and the decisions of the scientific body in these departments are regarded with some distrust. A sermon, a decision from the bench, a legal argument, often gives rise to criti- cism, discussion and remonstrance. And as to medi- cine, old Thomas Fuller tells us that the poets did well feign ^Esculapius and Circe to be brother and 5 sister, and both children of the sun; for in all times, in the opinion of the multitude, witches, old women and impostors have had a competition with physi- cians. There is a book, published some three hun- dred years ago, which professes to give an account of the notable sayings and doings of the fools of England. The fool of Nottingham being asked by his master what profession or calling had the great- est number within its ranks in that town, replied, " Truly, master, I think there be many more physi- cians in Nottingham than men of any other pur- suit." " A very fool thou art," replied his master; and the fool rejoined, " I will prove what I have said." He was encouraged to do so by the promise of a gold piece, and he went about the town with his face tied up as if he were suffering from a dreadful toothache. Every body he met pitied him, and every body too prescribed for him, and he noted their names and their nostrums, and being seen last by his master, and getting his prescription, he sub- mitted his whole list, and his master acknowledged that he had proved his saying. And can any one of us doubt that a similar investigation would lead to the same result in our day, and in the town in which we live 1 Is there not even reason to believe that the number of those who depend upon regularly educated physicians for council and advice, is less than in other countries and in other times \ And yet, at the same time, we can maintain the supe- riority of our art in our own age, and we have no reason to be ashamed of the medical men of our own country. We can point to great progress made in the 6 last and present centuries, and show how much has been found out in anatomy, in physiology, in che- mistry, in pathology. How much more we know of the human body in health and in disease than did even our immediate predecessors ! Success has crowned the zeal and the industry which have cha- racterized distinguished men of all countries in our own profession. Why then do we not command the respect and confidence of the community to a greater degree] Why do charlatans and nostrum-makers so abound 1 How are they so successful in the ac- cumulation of wealth X Why are they so much in repute % In the mechanical arts, in trade, the regu- larly educated, the pains-taking and hard-working men are universally called upon and confided in by the community. No one pretends that every man should be his own carpenter, or his own mason. Apprentices must serve for years before important matters will be entrusted to them, whilst any one who has failed in other things, may compound a medicine and prescribe for a disease. A full discussion of this question, and an answer to it, would not be possible nor suitable here. It must suggest itself as we meet together from various quarters to show our interest in the cause of medi- cal education. Some here present are commencing their medical studies, some may have snatched an hour from laborious professional pursuits, some of other callings have come to testify their sense of the importance of a sound medical education. We ap- peal to all for sympathy, and especially to the mem- bers of the other professions. For there are diffi- 7 culties common to all who would gladly contri- bute to the advancement of the professions, to en- able professional men to maintain the rank in the community which they may justly claim. One such is to be found in the imperfection of science and art. Theologians, lawyers and physicians must all con- fess how far they are from having mastered the mat- ters entrusted to their professions, how much there is which they cannot understand, how many pro- blems receive an imperfect solution. The expres- sion, " the glorious uncertainty of the law," is a very familiar one, and it may be applied in medicine and theology as well as in jurisprudence. The diffi- culties of the profession are well described by Van Helmont, and what he says of the 17th century is certainly true of the 19th. He tells us that he was puzzled by the question, "Lived not the Romans for five hundred years without physicians, and in a far more happy health than afterwards, when they had vanquished the Greeks, whence they privily re- ceived physicians 1" He thought of giving himself to the study of law, but " denied it and the govern- ment of others, because that the government of my- self was hard enough for me, but the judgment con- cerning good men and the life of others to be dark and subject to a thousand vexatious difficulties." He tells us " that being inclined to the study of natu- ral things, he devoted himself to medicine, he com- mitted the aphorisms of Hippocrates to heart, he read all the works of Galen twice, and all Avicenna —and as well the Greeks and Arabians, as moderns, six hundred volumes, reading them attentively, and 8 taking notice by common-places of whatsoever seem- ed remarkable." He collected plants, and learned all about them. Therefore, too, he goes on to tell us, " I would accompany a practising physician " ; and then, after all, he says, " I saw that fevers and com- mon diseases were neither certainly, nor knowingly, nor safely cured. Discerning thus the uncertainty and deceit of rules of medicine, I said with a sor- rowful heart—Good God, how long wilt thou be angry with mortal men ? How is it that thou ceas- est not to destroy so many families through the un- certainty and ignorance of physicians % " With so keen a perception of the deficiencies, omissions and short comings of the profession, he did not abandon it. " I fell withal on my face," he continues, " and said, Oh Lord, pardon me, pardon my indiscreet charity, for thou art the radical good of goodness itself. Thou hast known my sighs, and that I confess that I can know, am worth, am able to do and have nothing, that I am poor, naked, empty, vain. Give, oh Lord, give knowledge to thy creature, that he may affectionately know thy creature, himself first, other things beside himself, for thy command of cha- rity, all things to be ultimately in thee." " And in this conception," he goes on to tell us, " was there an inward precept that I should be made a physician, and forthwith therefore, and for thirty whole years after, and their nights following in order, I labored to my cost and damage of my life, that I might obtain the natures of vegetables and minerals, and the knowings of their properties. The meanwhile I lived not without prayer, reading, narrow search of 9 things, sifting of my errors and daily experiences written down together." And in the next chapter he lays down a proposition which may be somewhat lost sight of in our day, namely, that the hunting or searching out of sciences begins from know thyself. Are we not too much occupied objectively, with the knowledge that is to be acquired, and do we think enough of the instrument which is to apprehend and use the knowledge % The Greeks, to whom we owe the maxim Frvih gtavrov, may, to be sure, be open to the charge of having devoted time and energy disproportionately to the mind, to the intel- lectual processes. A great medical observer of our own day took for his motto for one of his first works, a passage from the Emile of Rousseau: " I know that truth is in the objects and not in my mind which apprehends them, and that the less of mine I infuse into my decisions the more sure I am of approaching the truth." Now mistakes are cer- tainly very common, and we need to be constantly reminded, whilst pursuing what is subjective, not to lose sight of the objective. Is it not true, how- ever, in our modes of education, that we are not giving sufficient attention to the culture and disci- pline of the several faculties, in our efforts to store the mind with useful knowledge X Whilst physiolo- gy is taught in our common schools to children ten years of age, young men undertake the study of the professions who have not learned to observe natural objects, nor to reason; and who show themselves deficient even in grammar and spelling, when called upon to record medical cases, or to prepare disserta- 2 10 tions. And if we inquire into the causes why phy- sicians in our day have less repute; why, in so many instances, they fail to administer relief, and we cannot attribute such short coinings entirely to lack of dili- gence or of success in the pursuit of knowledge, must we not admit that a deficiency does exist in mental and moral qualities, which proper training and discipline might have remedied, at least, in some degree ? Truth is before us; why do so many fail to apprehend it? Do we sufficiently study our- selves ; do we know enough of our own minds ; do we recognise the imperfections that prevent us from apprehending and receiving the truth ? It certainly is remarkable in the training of ancient physicians, how much pains was taken with their education. Thus Galen was early imbued with the philosophy of Aristotle by his father, who provided most care- fully for the education of his son. And Galen fre- quently speaks of his great indebtedness to his father for a careful nurture. He was placed by him under the platonist Gaius, then under a Stoic ; sub- sequently under an Epicurean. He was carefully trained in dialectics, and was very fond of geometry. We read of his going to Smyrna, on the death of his father, to continue his medical studies under Pelops, and at the same time to pursue the study of Platonic philosophy, under Albinus. He went to Corinth to become the pupil and assistant of Nor- miscianus, and subsequently travelled through vari- ous countries, spending some time at Alexandria, and was there the pupil of Helvetius. Galen attributes his great success in after life to 11 the training and discipline of his early years. He attached great importance to his studies in logic, dia- lectics and rhetoric, as enabling him to set forth per- suasively and convincingly the truths of medical science. He attributes to the study of mathematics a certainty of his being right, that he was thus prevented from skepticism into which he might have fallen by dwelling too exclusively amongst the con- flicting opinions of schools of philosophy. A recent writer tells us that " the well-educated physician under the Roman Empire, in common with his medical knowledge, was presumed to be familiar with the grammatical structure of his own language, with rhetoric, arithmetic, geometry, dialectics, moral philosophy, astronomy, and even with architecture." A contemporary of Galen, Madaurensis, who styles himself the not unknown priest, nor recent worship- per, nor unfavored minister of iEsculapius, says to the people of Carthage, of the goblet of the muses, " The oftener it is drained, and the more unmixed it is, the more it conduces to soundness of mind. The first cup, that of the reading master, takes away ignorance; the second, that of the grammarian, in- structs in science ; the third, that of the rhetorician, arms with eloquence. Thus far most people drink. But I have drunk other cups at Athens: the cup of poetry, the inventive; of geometry, the limpid; of music, the sweet; of dialectics, the roughish; and of universal philosophy, the never-satiating necta- reous cup." Galen was twenty-eight years of age when he commenced the practice of his profession, and we 12 know of Ciesarius, the brother of Gregory Nazian- zen, who practised at the court of Julian, and was the physician and intimate friend of Valens and Va- lentiman, that he had studied five years at Alexan- dria, having been previously at Cresarea. And the importance of preliminary studies and general cul- ture thus recognised by the ancients, has always been acknowledged. Let us look, for instance, at the culture of a distinguished physician of the seventeenth century. We read of Boerhaave that he was taught the Latin and Greek languages, and became early a proficient in both. When nineteen years of age he delivered a discourse before the Academy, in which he undertook to show how Cicero had overthrown the philosophy of Epicurus. He attacked Spinoza, and received a gold medal from the city of Leyden. He taught mathematics for some time, and was entrust- ed with looking over the catalogue of the library of Vossius, which had become the property of the city. He was twenty-two years of age when he began to study medicine. He received the degree of doctor in philosophy in 1689, and in 1693 that of doctor in medicine; and his success was fully commensu- rate with his long and careful preparation. You may remember that the city of Leyden was illumi- nated when the distinguished physician, of whom they were so justly proud, was able to leave his house after a dangerous illness, and to resume his lectures. Haller, the distinguished pupil of Boer- haave, was remarkable for his mental culture, for his early training in and knowledge of the ancient lan- guages ; and even for his poetical talents. How 13 much does Lord Bacon dwell, in his Novum Orga- num, on the right state of the faculties, and how significant is his expression as to the causes of error which he puts down as four kinds of idols! And idolatry, we must remember, is not merely the result of intellectual deficiency, but of moral and religious perversion. But, leaving these questions for a time, let us ask now what is done in our own day for medical educa- tion ; what are prevalent ideas in other countries and under other institutions; and I would call your attention for a few moments to the systems of France and of Tuscany, as of countries whose in- stitutions are very different from our own, but which we may study with profit. With us, the govern- ment does much for preliminary education, for schools, less for colleges, and still less for institu- tions devoted to professional teaching. The govern- ment in those countries undertakes to provide its subjects with well-educated, thoroughly trained med- ical advisers. The Grand Duke of Tuscany has lately re-organized the medical school. The Uni- versity of Pisa dates from the year 1384, and the medical faculty for instruction is attached to it. Students are received there after a preliminary exa- mination in mathematics, philosophy and the Latin language and literature. They are expected to study five years. There are twelve professors. In the first year the attention of the student is confined to medi- cal natural history, natural philosophy, botany and chemistry ; and these same subjects, with anatomy and physiology, are pursued also during the second 14 year. At the end of the second year, the student must pass his first examination. Anatomy and phy- siology are continued during the third year; mate- ria mcdica is added to them, and so are the rudi- ments of pathology, medical and surgical. A second examination on anatomy and physiology is held at the end of the third year; the third examination on therapeutics and the elements of internal and exter- nal pathology, is held at the end of the fourth year. Hygiene and legal medicine, entrusted to one profes- sor, are taught during the fourth year. Clinical medicine, midwifery and the history of medicine are subjects for the fifth and last year, at the close of which is the fourth and last examination, and the degree of doctor in medicine is now conferred on the successful candidates. They are not, however, al- lowed to practise, but are required to join the finish- ing school, and to remain there two years. This is established in Florence, in connection with a hospi- tal of some six hundred beds. Ten professors are attached to this school: one of medicine, one of sur- gery, one of obstetrics, one of comparative and re- gional anatomy, and of embryology, a fifth of patho- logical anatomy, a sixth of organic and medico-legal chemistry, a seventh of general therapeutics, an eighth of diseases of the eye, a ninth of diseases of the skin-, and a tenth of mental affections. The sur- gical clinic takes place in the morning at seven o'clock ; the medical at nine o'clock; the obstetrical at eleven. Theoretical courses are delivered from twelve to two o'clock ; the special clinics from three to five o'clock ; and at eight o'clock in the evening 15 the assistants of the clinical professors make their visits, and each student has one patient assigned to him, whom he is expected to examine, and for whom he is expected to prescribe under the direction of the assistant physician. The clinical wards are small, containing only about thirty beds ; but every patient coming to the hospital is first visited by the assistant clinical physician or surgeon, and such as are deem- ed most interesting are sent to the clinical wards. The autopsies are made with care in the presence of the students, all the appearances being recorded, and full histories of all the cases preserved. There is a good museum of pathological anatomy, and there are ample materials for dissection. The professors are paid by the government, which even provides the students with their dissecting instruments, so that they re- ceive their education gratuitously. After two years passed in this hospital, the students are examined by a board composed of the first physician of the Grand Duke, of two professors of the school, of two physicians of the hospital, and of members of the Medico-Physical Academy of Florence. There are three tests to which each candidate is submitted. He must answer questions in medicine and surgery; in legal medicine and in pathological anatomy; he must make a formal diagnosis in three cases taken from the clinical wards ; he must write a thesis on a subject assigned to him, and defend it. Having passed this examination, and after a seven years' study, he receives a license to practise. But the government does not leave him here. We find throughout Italy an institution called the Con- 16 dotta. Certain physicians are appointed and paid by the local governments, whose duty it is to attend the poor in that district. The young physician is thus at once provided with a livelihood, and, as his reputation extends, he can go to the cities where pro- fessional incomes are the largest. The government thus providing its subjects with well educated pro- fessional men, represses vigorously quackery and nos- trums. The municipal physicians are expected to give advice in all questions of hygiene, as well as to take care of the poor. This institution has come down from the days of the Roman Empire. The Archiatri were state physicians, and in Rome their number was equal to that of the wards of the city. They were chosen by the people of the municipali- ties, drew their salaries from its treasury, and they had many privileges, and their property even was exempt from taxation. If we compare medical education in France with that in Tuscany, we find many differences of detail. The French government does not do so much, though it appoints and pays the professors. The students, however, are required to take out inscrip- tions, as they are called, and to pay for each one. The course of study occupies five years. There are twenty-one preparatory schools in France, and three schools where degrees are conferred. Two of the five years of study may be spent in the preparatory schools, in each of which are six titular and two ad- junct professors. Of 2306 medical students in France about four years ago, 750 were connected with preparatory schools. There were more than 17 1300 students in Paris. The faculty of Paris is com- posed of twenty-six professors and twenty-four assist- ant professors. The lectures are delivered during two sessions of five months each. There are four lectures a day in the college, and clinical lectures at three different hospitals, every morning, from seven to ten o'clock. There are five examinations: the first on chemistry, natural philosophy and medical natural history, at the end of the first year. Ana- tomy and physiology are the subjects of the second examination ; internal and external pathology of the third; hygiene, legal medicine, materia medica and therapeutics of the fourth; clinical medicine and surgery and obstetrics of the fifth, at which a thesis must be prepared and defended. A diploma of bachelor of science, from a preparatory college, is required before taking out the inscriptions. There is not, however, in France, any institution corres- ponding with the Condotta of Italy ; there are no physicians like the Archiatri of the Roman Empire. The French government having contributed liber- ally to the education of the physician, lets him take care of himself, after getting his degree, which is also a license to practise. A constant stimulus is administered in the distribution, by the concours, of assistant professorships and the situations of physi- cians and surgeons to the hospitals. The school of •• perfectionnement," or finishing school, is peculiar to Italy, and it certainly has many advantages. In a smaller country like Tuscany, and in a smaller city like Florence, there can be more personal intercourse between the professors and the students, and we find 3 1* some of the advantages of the collegiate system of education. We cannot consider the many advan- tages of this old system, without regretting that we are losing in this country what we once had of it. Teachers and pupils, living together under the same roof, dining together day by day in the same hall, know much more of each other, and have much more in common. The educated classes of the com- munity are thus early brought into sympathy. Must we not lament that so often the members of the three professions in our own country are at vari- ance with each other—must we not wish that there were more of mutual support and defence? In the French preparatory schools, and at Montpelier and Strasburg, there would be more of community of feeling than in Paris. We find, however, the colle- giate system in medicine carried out only at St. Bar- tholomew's Hospital, in London. There a certain number of students have rooms in the hospital, and dine together in a commons-hall. It has been pro- posed, in France, to arrange in some way that stu- dents should spend more time in the provinces, and that they should be in Paris only for the last one or two years of their course, when they would be less likely to be distracted by the various objects of inte- rest and pleasure in that great capital, and more able to avail themselves of its advantages. In London there are so many medical schools, in each of which are not more than sixty or seventy students, that the advantages of personal intercourse are better secured. The medical faculty of Harvard College has not been unmindful of this object. Whilst it has not been 19 fevorable to increasing the number of lectures, nor the length of lecture terms, it has promoted the formation of summer schools, where, during eight months of the year, recitations and demonstrations are held, in which the pupil is brought into con- tact with the teacher, and the latter is able to find out something of the character and of the mind of the student. The Tremont Medical School was estab- lished in the year 1838, and a long list of its stu- dents, during successive years, affords the best proof of the efficacy of the system of recitations, as it is there carried out. Whilst in the Tuscan institutions the intercourse and sympathy between teacher and pupil is so well provided for, there are great advantages in the pro- tracted period of study. There, to be sure, gentle- men will not be so readily acknowledged by you who are commencing your studies, as by those of us who are looking back upon early professional life, and with whom its difficulties are matters of compara- tively recent experience. We cannot but admire the wisdom of the Tuscan government in thus enabling young men to devote so many years to study, and in protecting them from want and anxiety during the early years of professional life. He who would de- vote himself to the profession of medicine with us, must have much more capital, or he must devote more of his energies to providing for his daily wants than is necessary in Italy, or even in France. It is true that the period of study prescribed before tak- ing a degree is only of three years. But the degree with us does not immediately introduce to practice. 20 The public judge for themselves ; and the testimony of young medical men throughout our country is unanimous, that if the government thinks three years a sufficient time to educate a physician, the public prefers and insists upon a much longer time to pass over the heads of those who are to be intrusted with matters relating to health and life. I would say nothing to discourage those of you now commenc- ing your work. I presume, however, that you know somewThat of that which is before you. If, simply to make money or to get fame be your object, any study is unnecessary. You will find in all places ignorant practitioners of medicine, wealthy and well known. If you have the love of knowledge, if you find pleasure in the exercise of the various faculties with which you have been endowed, you surely will not be deterred from your course by being told that a life of study and of the constant exercise of mental and moral faculties is before you. WTe are told of that great artist, Michael Angelo, so accomplished in sculpture, painting and architecture, such a proficient in all the natural sciences, that when asked what he was doing, as he was walking in the Coliseum at Rome, after he had reached his eightieth year, he replied, " I go to school that I may learn." We also read of that world-renowned painter, Leonardo da Vinci, whose proficiency in mathematics and the natural sciences was so great, that one day, after he had passed his seventieth year, some one speaking to him of his long life and the probability that it would soon be terminated, he expressed regret only on one account, that he was but beginning to learn 21 to paint. And we can assure you, gentlemen, that in the calling you are taking up, the longer you live the more you will find to learn. We can do some- thing for you in the three years, which by law you must spend before you get your degree, in showing you where knowledge is, and in aiding you to train and discipline your own faculties. And here we can do only for the willing. In other schools and col- leges with which you have been connected, there was a kind of discipline and supervision to which we can make no pretence here. We can require attendance on a few lectures, wTe can examine you on matters there put before you, but we cannot control or re- strain you. Self-control and self-restraint must be daily exercised, if you are ultimately to succeed as trusted and honored physicians. Your intellectual faculties must be sharpened and your minds stored with useful knowledge. But this is not all; your appetites and passions must be brought into sub- jection ; kindliness of heart and courtesy of man- ner are most important objects of culture. A recent benefactor of our college wished that her contribu- tion should be devoted to a professorship charged with the moral and religious culture of the under- graduates, and the government of the University has established such a department, and placed in it a professor well known for his blameless life as well as his eloquence. And those charged with the duties of medical education would fail did they not strive to keep fresh in their own minds the great im- portance of moral culture, and were they negligent in reminding the students of the same. We have alluded, gentlemen, to the imperfections of our science and art. They are traceable somewhat to our intellectual weaknesses and deficiencies, but in a greater degree to frailties and infirmities of our moral nature. We profess to be lovers of and to search for the truth; why do Ave so often fail in our efforts? Is it not often because we love ourselves supremely; is it not often because the appetites and passions of our lower nature get the dominion over us ? To take care of ourselves is a high duty, and an instinct to secure it has been wisely implanted within us ; but, alas! does it not too often get the mastery, and interfere with the proper respect for the rights of and discharge of the duties towards our neighbor? The novelist, whose Dr. Sangrado re- plied—when the proof of the murderous effect of his bleedings was put before him too clearly to be denied—that he had written a book, and therefore could not change his practice, conveys, under this bitter sarcasm, a truth that we may well lay to heart. If we take up the history of our profession, are we not constantly finding men, with great intellectual powers, so in love with their own theories and dis- coveries, that they cannot acknowledge the success of their contemporaries or juniors, and are thus left behind, whilst the flood of science rolls past them. The founder of Caius College, Cambridge, made two gates. Every student must pass through the first, called Humility, before reaching the second, called Honor. And I would exhort you, gentlemen, not to omit the practice of the medical philosopher, to whose opinions and ways we have alluded, that of 23 narrow self-examination. Be assured, if each of you looks carefully into his own heart, you will find frailties and infirmities, which should make you humble, and thus fit you for the acquisition of true knowledge and of its rewards. The medical profes- sion deals much with human frailty and infirmity, and if you would treat tenderly those of others, you must have a vivid sense of your own. We live, too, in an age, gentlemen, when, with a keen sense of de- ficiencies and errors in existing institutions, there is a thirst for reforming them. And in actively parti- cipating in such efforts, we are but too apt to lose sight of the true source of evil within us. Did we know ourselves better, we could employ our energies more safely and wisely at home than abroad. The medical profession but imperfectly accomplishes its objects, and medical science is uncertain, and yet physicians are not sinners above all men ; they but share in the weaknesses and sinfulness of their fel- low men. To guard themselves and others against evils resulting from these weaknesses, is one object of the profession, and its laws, restraints, and dis- cipline are valued by all those with whom it is a daily exercise to maintain a good conscience before God and man. The very love of knowledge itself needs restraint and control. The charlatan, in ad- vertising his nostrum, gives a theory to explain its effects. In a half column of a newspaper he is able to reduce the art of healing to the level of the mean- est capacity. The physician, too, is often called upon in the same way, and the patient expects not only a prescription, but a lecture. His own conclu- 21 sions in diagnosis, prognosis and treatment, are the fruits of the study of years ; but he is expected to explain them clearly to the uninitiated in a very few moments. The medical systems and various schools in our profession are the fruits of this same desire to see and understand what cannot be embraced in one field of vision—what cannot be comprehended by finite minds. The mechanical, the chemical, the vital schools, the systems of Brown and Broussais, were vain attempts so to arrange all facts and truths that they might be perceived and their bearings under- stood by limited human faculties. Of this school of Harvard University, we may mention, with a proper satisfaction, that it has never been identified with a school or a party, whilst it has never refused to learn from all the distinguished men by whose labors sci- ence has been advanced. Let us, then, gentlemen, be mindful of the precepts and examples of our pre- decessors. Let us not ask more from science and art than it can give ; let us not pretend to a know- ledge which has not been vouchsafed to man. Whilst the charlatan understands and explains every thing, may we, as pupils and graduates of this col- lege, ever maintain a proper modesty and humility, knowing well what man may know, but realizing, with the illustrious Newton, that we are, after all, but as children gathering a few pebbles on the shore of the great ocean of truth. There is one other matter suggesting itself in this connection, on which I would fain say a few words. Our science, gentlemen, on one side has common ground with what is seen and known of all men. 25 All know something of the art of healing; who will not undertake to prescribe for some disorders ? On the other side we border upon the supernatural and the unknown. Life and death are mysteries; we cannot define them, we cannot comprehend them. Progno- sis is a department of medical science relating to them. It undertakes to predict results ; it is often successful, but very great mistakes are frequently made, and great discredit is often brought upon the profession in this way. And the reproof ad- dressed on this account is not always so gentle as was that of a young lady, the subject of the diagno- sis, advanced consumption, of the prognosis speedy death, who at the end of two years, during which she had been able to discharge many duties devolving upon her, and to take a part in society, remarked that she was ashamed to look a medical man in the face, thus continuing to live in spite of the decisions of his science. If we are often too venturesome in announcing decisions, all the elements for forming which are not in our power, it must be admitted that there is no point where we are more pressed for them than this. We can remind our patients that we no longer claim to be priests and prophets, as did the early practi- tioners. It is well for us if we are thoroughly per- suaded in our own minds of the true source of super- natural influences, and it would be well if the public were so too. Though we live in an enlightened age, amidst claims for the supremacy of human sci- ence, we certainly find that false pretenders to super- natural powers, that spiritualists, necromancers and 4 26 astrologers, have in all classes of society those who trust in them and reward them liberally. I do not deem it out of place, Gentlemen of the Medical Class, thus to call your attention to this subject. He who would cure bodily diseases, must make himself all things to all men, in some sense like his profes- sional brother who administers to spiritual maladies. And in doing this, in adapting his discourse to those not versed in science, there is danger lest he dimi- nish his own powers of reasoning, lest he become loose and inaccurate not only in language but in thought. He may reduce science to the level of the mind of the uninitiated, to the loss of his own per- ceptions. Intercourse with his professional breth- ren will be a safeguard here. And if tempted to exalt his own powers, to think more highly of him- self than he ought to, let him come to the other bor- der land and look out into the broad expanse of the mysterious and the unknown. There is a proverb of reproach against our profession, Ubi tres medici ibi duo athei. Let us not in our own cases do anything to justify such a saying. Let us remember that truth is of divine origin. Laennec, to whom we owe such a valuable aid in the discovery of truth as is auscul- tation, speaks of the discovery as one vouchsafed to him, and remarks that great discoveries generally come in this way, that they are not wrested out by hard thinking, but transmitted through chosen chan- nels at the time appointed by the great Author of all things. And, Gentlemen, as a proper appreciation of the supernatural is valuable and important for intellec- 27 tual health and growth, it is still more so for the well-being of our moral nature. Medical men see so much of the evils of disorderly passions and appe- tites, that they ought to value highly whatever will bring and keep these in subjection. We read that he who ruleth his own spirit is greater than he who taketh a city. How forcibly, how constantly is this truth brought home to those who minister in sick chambers and by the beds of the dying! We read, too, that the fear of the Lord is the beginning of wisdom. How important this truth for physicians, so much confided in by patients lacking the intellec- tual training to appreciate the soundness of advice, and often the moral sense to remunerate properly their arduous services ! I have dwelt at some length on the difficulties of our undertaking, and have spoken of other countries where much is done for medical education. We must not, however, be unmindful of what we have received. We must not forget that the land on which our college stands was the gift of a generous member of our profession. We are now solicit- ing from the wealthy and the liberal the means to pay the debt contracted in building the present col- lege, and we must acknowledge a grant of the Com- monwealth towards completing the former college in the year 1814. The principle has been acknow- ledged in our community, that college buildings, that museums and libraries, must be provided, that scholarships must be founded, but it should be more fully acted upon. Those fit to receive an education 28 are very often unable to pay for it. 'There is at pre- sent a heavy tax upon students, and an inadequate remuneration to teachers. The members of the pro- fession have always acknowledged their duty to teach to others what they have learned, and there is no disposition to shrink from it. Whilst medical men have given of their substance in this cause, we would call attention to how much was done person- ally by the first professors in this school. Until the year 1811, their income was limited to the proceeds of the foundations of the professorships, and then a salary of five hundred dollars was voted to the professor of Anatomy and Surgery and to the professor of Theory and Practice. And when the fees from students were assigned to them, yet we must all admit that their labors involved a pecuniary sacrifice. Had they devoted to private practice the time and strength spent in discharging the duties of their professor- ships, how much greater would have been their pe- cuniary compensation! We, who enter into their labors, should be grateful for what they have done, and be mindful of the example. The three earliest professors of our college have long since been taken to their rest. Of their immediate successors, one is but recently dead. We all may remember him well, and should delight in bearing testimony to his zeal and fidelity during many years of active service. We are now enjoying the fruits of his labors; we are surrounded by the monuments to his untiring indus- try. In his example of devotion to his profession, of scrupulous exactness and fidelity, how much is there worthy of imitation ! And we cannot but con- 29 gratulate ourselves that so many of his associates and colleagues are still spared to cheer us by their presence, and to guide us by their counsels. If I may be allowed to refer especially to the Senior of all, the Professor Emeritus of the department the duties of which he discharged with such ability and fidelity and for so many years, I would point him to you, Gentlemen of the Medical Class, as an exam- ple of the possession and successful culture of those moral and intellectual faculties, of the importance of which I have said so much. The epithets, a scholar and a gentleman, so dear to every true professional man, may well be applied to one who in long years of intercourse with patients, with students, with profes- sional brethren, has received their united testimony to his correct observation, his sound judgment, his scrupulous regard for the rights and his delicate consideration for the feelings of others. May his precepts and example be lost on none of us who have come together here to-day in the cause for which he labored so zealously, so wisely and so successfully! Aw I • t \ v'V \\