AN ADDRESS TO THE GRADUATES OF THE MEDICAL DEPARTMENT THE COLUMBIAN COLLEGE THOMAS MILLER, M. D., I'ROrr-JSOR OF ANATOMY and physiology, de\n of THE MFWU, FACULTY, &' ——— w£ Delivered March 2, 1842. -o~ ( WASHINGTON; BLAIR AND RIVES, PRINTERS. 1842. ADDRESS. Gentlemen: Few professions require a greater and more extensive knowledge of science than that of Medicine. It is not the simple and easily attained profession it is thought to be by those who are ignorant of it: and this idea of its easy access, I fear, obtains even among many who have adopted it. Few, I conceive, estimate the amount of labor, the priva- tions, and the sacrifices which are to be endured in the attainment of their profession; and even when the con- sciousness of these exists, they are not apt to consider the great responsibility which rests on the professor of Medi- cine. Let us for a moment view the young beginner in the science, taking his first lesson in Osteology: does he seem aware of the extent of the labor he is to encounter ? No: nor is he conscious of this till advanced in the study. He then, for the first time, entertains a more rational concep- tion of the nature of the task he has undertaken. He sees how much time and close attention he has to devote to his studies, before he can reach any thing like proficiency. He perceives that the mastery of these difficulties is not to be effected but by great labor, intense thought, and the most devoted and exclusive application of his whole time and talents. At this time, his aim and object is a diploma; and he assures you of his willingness to undergo all, pro- vided this hope is held out to him. At the commencement of his studies, he views the period when he will be enabled to graduate as very remote; but he feels assured that when he has reached it, there will be a reprieve—a rest from his 4 labor and sacrifices, and that the diploma will bring with it ease, comfort, and certain success. How far these hopes may be real, or how far imaginary, depends much on circumstances. Close attention to the study of the science of Medicine is indispensably necessary for success in the study, as well as in the practice of it; and how much ease and comfort will be the consequence of the reception of the diploma, depends much on the suc- cess in the study, and equally as much on the natural manners and attributes of the student. By this I mean that there are natural gifts, both of mind and manners, on which the success of one entering the practice of the pro- fession depends, as much as on the ardor and perseverance with which he may have pursued the mere study itself; and these are essentially necessary to the attainment of a high standing in the profession. These attributes are of a mixed kind; they are for the most part innate, but capable of being greatly improved by close observance of them. In some minds they exist in so perfect a state, that they require little more than to be brought into exercise. The natural qualities of the mind are : 1. Quickness of perception. 2. Sound judgment, with nice discriminating powers. 3. Moral firm- ness, great integrity, combined with tenderness and deli- cacy. Setting out in life, then, possessed of these gifts, having formed a solid basis in your profession by previous studious habits, success must necessarily attend you, par- ticularly if you have superadded to these a sincere devotion to your profession. Let us cursorily examine the advantages of these na- tural gifts. Quickness of perception is rarely possessed in a high degree; but the benefits which result from it you will at once see by visiting the sick chamber with one who does possess it. At a glance he will have a greater insight into the nature and stage of the case, than another would gain after a long and tedious examination ; and if he has 5 judgment, with nice discriminating powers, he will conceive at once a more perfect knowledge of the case, and apply its appropriate remedies far more promptly and accurately. In cases of great obscurity, or of emergency, these faculties are particularly useful; in a greater or less degree, they are im- portant in every case. Without them, the practice is irksome; the practitioner is ever involved in difficulty and perplexity, and he never can hope to succeed. And here you will per- ceive the great advantage which one mind possesses over another, even where the education, &c, are equal. And we can account for the greater proficiency, the greater pre-emi- nence of one physician over another. We find in every eminent man these attributes; without them, I do not deem it possible for one to reach the highest elevation in his profession. These, however, only lead to the detection of disease, its exact location, its stage, its precise form,—the idiosyn- cracy, the diagnoses, prognosis, and appropriate remedies more promptly, and more certainly, than would be done in a mind of the opposite construction. But they require for their perfection the next series of attributes, viz : Moral firmness, integrity, tenderness, and delicacy. There is no profession in which there is a greater de- mand for moral firmness than Medicine. A man may be bold; he may promptly resent an insult; he may meet an enemy, and defend himself with marked heroism : but this does not imply the firmness to which I allude. The two are distinct. The bravest men we meet with are occasionally deficient in moral firmness. What, then, do we mean by moral courage or firmness ? It is a higher and more intel- lectual attribute. Like judgment and quickness of percep- tion, it is for the most part natural, and cannot be acquired ; though, where other faculties of the mind exist, which 1 cannot here delineate, it may in a great measure be substi- tuted for moral courage. Its possessor is then a favored. 6 man; he is firm and decided in the pursuit of his object; he is determined and unwavering in his opinions ; and in his intercourse with his fellow-man, he is not readily driven from his views when they are taken; he combats with decision the difficulties with which all professional men are surrounded. As a surgeon, he is firm; and when engaged in an important operation, he is not thrown off his guard or discomfited by any untoward accident. He inspires with confidence all around him; when danger is menaced, while others are unnerved, he is cool and dispassionate. Without it, he would never undertake an operation attended with hazard. He would rather consult the popular feeling, than the impulse which would actuate him to relieve suffer- ing humanity. He does not then stop to inquire—would this be politic ? would it be sanctioned by his professional brethren ? but, as I have said, he assumes the responsi- bility, conscious of his own correctness, having nothing in i view but the good of his patient. n You will see, at once, that this faculty requires to be tempered with judgment. If it be not, it leads at once to rash and reckless deeds, and opinions, and obstinacy; they must, therefore, go hand in hand, in order to be useful and valuable. It is this which enables us, when in the right, the right to pursue; and when in the wrong, to avow our errors, fearless of what might be said of retraction and cowardice. I might detail from the history of American physicians many instances of this noble attribute, but your own minds must supply the deficiency. Nor is integrity of less importance than those attributes [ have noticed. Men who have daily intrusted to them the confidence of their fellow-men—who, from the nature of their profession, are made the repositories of the most delicate secrets of not only our own, but the other sex, have at least as great necessity for this attribute as any other. Need I remind you of this ? Need I remind you 7 that without this you are unworthy of the high vocation you have assumed? How often does it occur that im- portant communications are made to us, by those to whom we are called to administer relief and consolation ? Trust- ing to the sacredness of our vocation, they confide to us (under the impression that this confidence is necessary to the full comprehension of the case) the inmost secrets of their bosoms : thus placing at our disposal more than reputation,—a betrayal of which would prove more destruc tive to them, and more poignant in its effects, than the sacrifice of life itself, induced by ignorance. But this is not the only instance in which this attribute is necessary. Every medical man owes to the world a duty, which, as a man of humanity, he should repay, as far as possible. He should extend his usefulness beyond the sphere of his practice; and this is done by communicating the result of his experience and observations, for the bene- fit of mankind, through his professional brethren, which become more valuable as he advances in life. Now, if he is deficient in integrity, what will his statements, either verbal or written, be worth ? Who will place any reliance on them ? The faculty of exaggeration, it has been said, is a very (and a far too) common one of our profession. This is fortunately done orally, and in the community where the individual resides, and where he is known. Thus we hear such a one detailing wonderful cures, which he has never effected; operations which he has never per- formed; interesting pathological and therapeutical phe- nomena, which existed but in his own brain. This is done to elevate his character among the unprofessional, and gain him practice and. reputation, and is passed over as worthless by his professional acquaintances. If such arti- fices be reprehensible, how much more so are the false statements which are imposed on the public—with the sanction, too, of the periodicals of the day, thrown into the hands of the juniors of the profession, as they must be? 3 Instead of serving as guides and mentors in the practice, they rather lead astray, and cause errors too serious to be called to mind. It is to be feared that in this age, when there is such a rage for book-making, there are many false facts, many imaginary experiments, many hypothetical the- ories, put forth and palmed on the world as the observa- tions and experience of their authors. It is a popular belief, (and I am induced to entertain it,) that none possess a greater control over the feelings and prejudices of the community than medical men; and this I say, I believe, provided their course of conduct is such as to warrant it. This controlling influence of the medical man is engendered as much by his manners as by his learning and skill. The public have no method of judg- ing of the qualifications of a medical practitioner, except by his manners, and the course he pursues towards his patients; and hence his success is much influenced by his mode of conducting the examinations of his patients. We are all much indebted to the fair sex for our advance- ment. They rule us, as well as the rest of the world; and in ruling, they either make our fortunes or destroy us. On the fairest portion of creation, we have then to rely for our success. But they are not to be imposed on. They may, for a while, be attracted by a handsome, fancy doctor—one who knows how to dress, and is able to entertain them at a ball or soiree, and to repeat poetry to them. Such a one would, for a time, attract their attention, and possibly receive their patronage, and even their recommendation. But I say they are not to be imposed on. They are too good judges to be entrapped by such outward show. It is in the sick chamber that they are called on to estimate the value of the medical man, and the first thing that strikes them is the manner in which the doctor examines his pa- tient. This should always be done with tenderness and delicacy; always with a due regard to the disease and situation of the patient, as well as the sex. In your investi- 9 gations of a case, be tender ; inflict no more pain or fatigue than absolutely necessary; and exhibit in your inquiries the utmost delicacy. Be careful neither to inflict pain on your patient by rude handling, nor shock delicacy by improper language ; either of these, however skilful or learned you may be, would insure you (and justly, too) an ejectment from the sick room. Harshness is construed into ignorance. Even your manner of entering the room, and taking your seat by the side of the patient, is noticed. The late Dr. Dewees rela- ted an anecdote of a medical gentleman being pronounced ignorant, merely from the manner in which he placed his chair by the side of his patient. Besides being an advan- tage to the success of the medical man, mildness and delicacy often tend to promote the recovery of the patient. Who has not seen the happy results of kind and soothing language on the spirits of a patient? Who has not wit- nessed the effects of delicacy in the examination of a pa- tient? I knew a medical gentleman, of high standing, who was discontinued after his first visit to a lady, be- cause he had not observed this injunction of delicacy in handling and investigating her case. Let me assure you, then, that manners are to be studied as much as etiology or symptomology.* * Notwithstanding I have advised this course to all practitioners, I do it with a full knowledge that an opposite one has succeeded with many emi- nent men. Thus we see singular and eccentric men extensively employ- ed, and by their manners gain great credit and reputation. You may all recollect the advice of Radcliffe to Mead, when the latter was commenc- ing practice: " There are two ways for a physician to treat his patients— either bully or cajole them." He pursued the bullying plan, and succeeded. My preceptor, the late Doctor Henry Huntt, owed his success very much to his manners; and he pursued this independent, decided course towards all his patients, and thus often inspired confidence, and revived the despond- ing patient. I should greatly prefer the manners of Fothergill, who is said to have had " great purity of manners, self-government, and most absolute command of his passions," &c. 2 10 J.^et me next call your attention to the importance of your profession, not only to you, but to the community. I need not remind you that you have selected an exalted science as your profession, and that this is of perhaps more importance to the community than to yourselves. The professors of Medicine should be men of liberal and enlarged views. If regarded in any other light, it be- comes a mere trade, practised solely for gain. By a decree of the Almighty, all mankind have been rendered liable to disease—the poor as well as the rich ; and in the insti- tution of the science of Medicine, he illustrates the depen- dence of one man on another. In the practice, then, of your art, you are to bear this in mind—that the poor as well as the rich are to receive from you the benefits of those talents with which God has endowed you. From the rich you are expected to receive a just and liberal compensation for your services ; this you should exact as your due, and they will not hesitate to grant it. But for your attendance to the poor, your remuneration is to be from another source. Remember Boerhaave's adage, " that the poor were his best patients, for God was his paymaster." Another advantage incident to what is termed pauper practice is, that it is among the poorer class you meet with the most interesting cases—cases which furnish you with the richest lessons in your profession. View it, then, in this light, as one of an exalted character, designed to fulfil the dictates of charity and human- ity; and in its practice disprove the popular impression of its being a selfish and sordid art, acquired in a day, and designed merely for personal comfort and aggrandize- ment. Little do those who entertain this idea know of the difficulties we have to encounter; little are they aware of the many lonely and painful hours we have to endure, first in the attainment, and subsequently in the prosecution of our profession; of the sacrifices, the dan- gers to life and health, to which we are exposed. They see only the fair side. While the rest of mankind are ta- 11 king their rest, or enjoying the comforts of their domestic firesides, surrounded by all the endearments of life, and enjoying the pleasure of repose and relaxation from the cares and anxieties of business, the medical man is either engaged in the loathsome task of searching out the mys- teries of some obscure disease; or studying the machine which is likely to be diseased; or taking his solitary ride to visit some poor sufferer, who is anxiously watching for his arrival. Perhaps, this patient is the father of a large and helpless family; perhaps, an only child of a wealthy and aged parent. And now compare the state of his mind with another: who can appreciate his feeling when he is con • scious that on his skill so much depends? Compare the life of this man with that of any other profession. The duties of the one are never ending; his cares, his mental and bodily labor, know no period of repose. In his hands are life and death. His mistakes or errors of judgment are attended with consequences for which there is no remedy. The life that is sacrificed by his want either of skill or attention can never be recalled. See the surgeon: what is his state ? On the steadiness of his nerve, the keenness of his eye, and the soundness of his views, depends the life of his patient. In what other vocation is there such respon- sibility—such intense wear of mind and body ? Such, gentlemen, is a slight view of the nature of the profession of which you are now members. Having entered it, you are to bear this in mind—for it is most important that you should hold your profession in a proper estimate. Being of divine origin, it cannot be valued too highly. In thus estimating it, you are compelled to take a proper view of all your professional brethren, your co-laborers in the great work of humanity. While you are exercising your abilities for the good of mankind, you cannot con- sistently refuse charity to your professional brother ; culti- vate towards him the kindest feelings ; exercise towards him the greatest liberality; be sincere, candid, and courte- 12 ous : but never carry these to excess, nor let jealousy or envy enter into your feelings towards him. These, where the first evidence of their existence is evinced, should be instantly plucked from your bosoms ; if not, they will grow and strengthen with time and age, and be- come at last a Promethean fire, destroying self-esteem, con- fidence, and happiness. Curb such feelings at once, should they ever exist in youi mind; crush them, as you would the infant viper: unless you do, as sure as they reach ma- turity, they will prove as fatal to your peace of mind and happiness as the poison of the Cobra would to your body. Avoid strife with your medical brethren, and particularly avoid public altercation ; for, so far (even when you are in the right) from elevating you in the eyes of the public, it will depress you, and prove detrimental to your profession. I do not intend, however, that you should avoid argument on professional subjects. On the contrary, you should not remain passive in the medical world. Contend fairly, hon- orably, and openly, with your brethren for supremacy and superiority in your profession; but let this superiority be adjudged you from your merits, and not from any dishonor- able trick or artifice. An upright and ingenuous course tends much to unite the profession; and will gain to you many friends, not only among its members, but from the community at large. Besides a courteous and gentlemanly course of conduct, you owe to your professional brethren, as well as to your- self, promptness and punctuality as to time. In your prac- tice it will often become requisite for you to meet them at appointed hours. Let me advise you to be punctual to these appointments. All-important as punctuality is in the pursuits of life generally, it is particularly so in our profession. If neglected, there is a great sacrifice of time, of the value of which you should be aware. You should bear in mind, that, though the delay of a few moments may not produce inconvenience to you, it might so de- 13 range the engagements of another as to throw him back for the rest of the twenty-four hours. You should ever so commence the day, as to insure full time for a perfection of your whole duty. To do this, some standard and fixed rule should be laid down by every one, and adhered to as far as practicable. By adopting a regulation of this kind, you will lose less time, or rather gain more than you have the least idea of. Remember that life is short; but that in this short life, man has much to do before he has fulfilled the designs of his creation. Let me advise you, then, to commence with fixed rules relative to your daily occupations, from which you should never depart, unless forced by circumstances not under your control. Many have endeavored to divide the twenty-four hours, so that the several vocations may be fulfilled. The best arrangement of time I have ever seen, and the one which presents the fewest obstacles, is as follows: The medical man has to commence the day with his duties to his patients ; for this let him set apart six hours, which in ordinary countries and seasons of the year will be suffi- cient ; to the young practitioner this number will certainly be sufficient: for study, four hours : for religious duties, two: for meals and recreation, four; and this will leave eight hours, in the twenty-four, for repose. Let us see how this period of time should be spent, more in detail. In visiting your patients, the course of tenderness and delicacy towards them, of which I have already spoken, should be observed in the first place. But there are some other duties, which require your special attention, both while in the sick room, and after you have left it, which are of infinite importance. You enter the sick room as gentlemen. No gentleman requires to be told how he should enter a room. The agitation and flurry of your patient, consequent on your visit, having subsided, proceed to examine, with care, into the case; and do this rather with the view to inform yourself of its real nature, than to 14 impress him and those around you with an idea of your greatness, skill, and importance. Do not pursue your exam- ination further than is absolutely necessary for the under- standing of the case ; at the same time, do not make up your mind as to its character, till you are perfectly satis- fied. During your visit, let your conduct be cheerful; you should neither evince levity, nor be austere, or too reserved in your manner; for, as I have said, manners have a most controlling influence on the minds of patients. Having satisfied yourself of every particular in the case, (trusting nothing to the statements of others, particularly relative to the secretions,) uninfluenced by the suggestions of those who surround you, and who are ever ready to vob unteer their opinions, make your prescriptions and give your instructions in a concise, clear, and distinct manner—in writing, if possible. A neglect of this particularity often leads to the grossest blunders; an instance of which re- cently occurred to a medical friend of mine, in which the patient, not understanding the directions, actually swal- lowed a suppository of soap and opium. You are all, I have no doubt, familiar with the story of the lady who had the leeches designed for her epigastrium nicely fried and stewed, and then ate them. Let me advise you, also, to be particular in instructing your patient how the medi- cines you may order him should be taken. A disregard of this will cause him much perplexity; and possibly you may find him, upon repeating your visit, seated in a " wheel- barrow," swallowing the portion ordered to be taken in " any convenient vehicle," this being the most conveni- ent. Inform the attendant of the manner in which you design your medicine to act; then leave your patient im- pressed with the belief of his speedy recovery. Never express an opinion of your patient's case, unless circum- stances (such as approaching death, and desire for con- sultation) render it necessary. But when called on for your opinion of the patient, by those who have a right to be informed of his condition, give it plainly, candidly, and 15 in such terms as will neither confuse the listener, nor ren- der your language liable to be misunderstood. Where ob- scurity in the case exists, state this; for if you give a positive statement, relative to the condition of your patient, and that statement afterwards turns out to be inaccurate, your repu- % tation will suffer.* Never speak of your cases out of the sick chamber, un- less it be to a professional man. Never remain longer in the sick room than absolutely necessary to ascertain the nature of the case and to prescribe the proper remedies. And let me advise you not to pay too frequent visits to your patients : if you do, the inevitable effect produced on the mind of the patient or his friends will be, that he is worse than you had represented him, or that the doctor is run- ning to make a bill. Rather let the patient desire your presence, than become tired of seeing you. In cases of severe illness, you will frequently be requested to allow the patient to have the benefit of a visit from his minister. This is often a most delicate task. Where no actual reason exists in the nature of the case, when the counsel and * I am aware that this honorable and candid course has not the sanction of all the profession, though it has of all the honorable men in it. Thus we read of physicians of high standing, who prefer to deceive their patients, rather than to admit their ignorance; as the case of the physician who in- formed his patient that " castor oil was made from the beaver." Some men exhibit great tact and readiness, both in deceiving their patients and in concealing their ignorance, as in the case of a medical gentleman who, being asked by his patient how long she would be ill 1 promptly replied, '•' Madam, that depends on the duration of the disease." I do not think our Yankee ladies would have been satisfied with this sage reply, and been " much obliged to the doctor for his information." It would be far better, when a question is proposed to you that you can- not answer correctly, to give an evasive answer; or to pursue the plan pointed out in a story told by Coleridge, of a lady who had a husband not overburdened with brain, but yet had sense enough to hold his tongue when in company, and thus got credit, by " taciturnity," for wisdom, or for having the mind always dwelling on Locke or Newton. 16 spiritual conversation of the minister is asked, for the de- clension of this, acquiesce with pleasure; for, when timely and judiciously administered, they exercise a most sooth- ing and happy effect on the sick ; tend materially to the production of convalescence; and where death is inevitable, rob it of its sting, quiet the perturbed spirit, and smooth the rugged path to eternity. But cases do arise where it would be manifestly improper for the patient to be dis- turbed, even for so holy a purpose. In such an event, where the life of your patient depends, in your opinion, on his being kept perfectly quiet; where the least excitement would endanger his life, or tend to aggravate the case, you should firmly declare your disapproval of such a step, and state your reasons against it. Most generally, this will suf- fice; and, indeed, 1 have always found it sufficient, where the minister is a reasonable man and a gentleman. But instances do arise, where the minister loses sight of every thing but the desire to place the sick man's mind in a " god- like train;" and this he will do, or try to do, at the risk of producing death. Another difficulty will sometimes present itself to you, in your attendance on patients—the propriety of calling in a consulting physician. As a general rule, consultations should ever be encouraged in obscure and difficult cases; and it will become your duty to state the necessity of such to the patient or his friends. When this devolves on you, it should be done in the most cautious and delicate manner; so as not to produce a fatal depression in the mind of the patient, nor to excite unnecessary alarm in that of his friends, or pro- duce an impression of a want of self-confidence on your part. When this request comes from the attending physician, it is generally acquiesced in at once; for the sick, as well as the friends, are always anxious to increase the number of medical advisers. When the proposal for a consultation comes from the patient himself, or his friends, you of course will accede at once to it, even when, in your opinion, no real necessity 17 exists for such additional advice. Difficulty often arises in the selection of a consulting physician or surgeon : always throw this on the patient or his friends, if possible, and accept whomsoever is offered to you, if he be a gentleman, a regularly-bred physician, and an honorable man. If he be neither of these, decline meeting him, and, if necessary, state your reasons, and offer to relinquish the patient to his care, should such be the desire of the patient or his family. The question arises, Suppose a medical gentleman, with whom you are not on speaking terms, is offered to you in consultation: are you to decline meeting him ? This, of course, will depend much on circumstances. The mere fact of your having had a difference of an honorable nature, should present no obstacle to your meeting him in consult- ation; for no man with proper feelings would ever carry his personal prejudices into the sick chamber, or the cham- ber of death. In relation to professional intercourse with irregular practitioners, or those who are termed " quacks," let me recommend to you never to meet them, nor coun- tenance them in any manner whatever. By pursuing a dif- ferent course, you would at once injure your profession and your self standing, and give countenance to public imposition. When the selection of the consulting physician or sur- geon is left to you, as it most frequently will be, make your choice from among your medical brethren, with reference purely to your confidence in the individual selected, and be not influenced by your personal or friendly feelings. Of course, where you have a personal friend, on whom you place every reliance, and from whom you are conscious you will derive as much aid and good counsel as from any other source, your feelings would prompt you to call him; but here let me advise you never to place yourself in such an attitude to any medical friend, as to cause you to feel bound to call him in preference to others. In your consult- ations, let me recommend to you to be guarded, whether 3 IS you be attending or consulting physician or surgeon, in the language you use; and never let your conversation be over- heard, if possible. As an illustration of the ill effects of this, and mal-interpretation of the language of the phy- sician, allow me to detail the following, taken from the Medico-Chirurgical Review: " A very moral young gen- tleman had been undergoing some violent exertions, by which he had strained the walls of the abdomen. He complained of a good deal of stiffness and pain above the pubes; and an apothecary, whom he consulted, ordered leeches, followed by fomentations and poultices. There were only the mother and an old nurse in the house with the youth, and they became naturally suspicious at leeches and poultices to a part which they were not allowed to ex- amine. Mr. Hunter was called in; and the nurse, who was very curious to determine exactly how matters stood, applied her ear to the door, and overheard him telling the apothecary that there was a severe strain of the abdominal muscles. She ran directly to her mistress: " O ma'am, it's just as I thought!" "Why, what's the matter?" "O ma'am, master Thomas has been and strained his abomina- ble muscle." Another practice should be observed in consultation— that is, do not let any prevailing favorite theory or doc- trine so operate on your mind as to prevent your weighing with attention the suggestions of your colleague. Some medical men carry this singleness of idea in their profes- sion so far, that it becomes neither desirable nor pleasant to consult with them. Some are so wedded to a particular theory, doctrine, and class of remedies, that those who know them can foretell, before they enter the sick room, what course they are likely to pursue. While one single idea pursues some practitioners throughout their lives, others are on the other extreme, and have hobbies which they ride to death in a few months or weeks, and then abandon them forever. Another class have no fixed ideas 19 on any medical point, and therefore are equally as objection- able as either of the first class; and each of these may be well read in their profession. In the first two, credulity and prejudice seem to give rise to the favorite doctrine; while in the latter class, their vascillating condition is owing to a want of a well-digested course of study, and the habit of thorough investigation. Such men are not fit to pursue the practice of Medicine. I need not remind you that there is a fashion in medicine as in any thing else, and this forms another barrier to successful practice; for some are so constituted as to adopt every new remedy, because it is the fashion. This forms another objectionable class ; and such men as these are not only bad practitioners, but are unworthy of the noble profession of which they are mem- bers ; for the practice of the profession, in order to be suc- cessful, must be eclectic. Before leaving this subject, let me give you another caution relative to the language you use, either to your pa- tients or in their hearing; and this I will illustrate by cases which have actually occurred. A medical gentleman was attending a case of St. Anthony's fire, and so termed it to the family, who were not satisfied; they consequently requested the attendance of a second, who, having more tact, pro- nounced the case one of erisypelas. I need not tell you that the latter was considered the best doctor, because he used a term which they did not understand ; the first was, of course, dismissed for ignorance. A medical friend of this city was once requested to examine a case, and, when asked what was the matter, he told the patient it was a split artery. Immediately the patient wished to know whether his first medical adviser could not have prevented it. Be cautious, then, in the language which you use; and en- deavor to apply exactly the same terms to the disease, and let there be an accordance of terms, &c, between your- selves and medical friends, as far as practicable—particu- larly in consultations. 20 The next subject for consideration is the employment of your time after you have left the sick room. There are few cases which occur to a physician which do not possess some interest; and although this may not strike you while in actual attendance on the case, after it has terminated, if you can have it in your power to review and revise it, it will prove not only interesting, but also profitable to yourself, and, possibly, even to others of your profession. Therefore, let me advise you, in commencing life, to have these two objects in view, viz : personal improvement and acquisition of knowledge, and the extension of your know- ledge and experience among the profession, for the benefit of mankind. With this view, keep a regularly and sys- tematic record of your cases, noting every peculiarity, pre- vailing epidemic, type, your pathological view, and treat- ment ; and do not stop here. When you are so unfor- tunate as to lose a patient by death, pursue your observa- tions by autopsy, whenever it is practicable: than this there is no more fruitful source of medical knowledge and experience; by this you are enabled to test your views and opinions prior to death, and to correct any errors in diagno- sis, treatment, or prognosis you may have made. In the performance of autopsies, never hurry; take time and do it thoroughly. An autopsy carelessly and negligently made, can serve no beneficial purpose either to yourself or to science ; and, when finished, compare what you have discovered, with the view you formed of the case prior to death. In the pursuit of morbid anatomy, difficul- ties will arise in getting the consent of the friends of the deceased. If neatness is observed, and the operations are performed with a due regard to their feelings, it will have the effect of doing away this prejudice more than any other argument, and consent will often be procured when there is an assurance of this, with calling to their minds the fact that the operation is designed for the good of the liv- ing, for the alleviation of human suffering, and that it can 21 be attended with no injury to the dead. The record of cases, with autopsies, will form a material item in your time for visiting your patients,;and the extension of know- ledge. But it will not, and should not, fill up the whole time that should be devoted to study. An impression of- ten exists among young gentlemen, that after they have gone through a collegiate course, and received their diplo- ma, the period of study is at an end; that they have ac- quired all the book knowledge that is requisite for a pro- fessional man ; that they are now to adopt the motto of the celebrated Patrick Henry, and study men, not books—that is, get experience. However important this adage may be in other professions and pursuits of life, it will not hold in ours. After graduation, your greatest labors have just com- menced. You have but entered the threshold of your profession, and have theiefore to pursue a more extensive system of study than you ever yet have done. Set about at once procuring a library of well-selected books on the sub- ject of your profession; and do not confine yourselves to the most recent works. Store your shelves with the valu- able works of Boerhaave, Yan Sweiten, Sydenham, Hux- ham, &c, as well as those of Rush, Good, and Wilson; and add to them the standard books of the present period, on all the various subjects of your profession. I cannot advise you too strongly to take one or two of the best periodicals of the day—English and American. With these as a foun- dation, and then pursuing the advice of a celebrated divine to a young friend—that is, to procure one book at a time, and study that before you get another—in a few years you will find your library well stored with valuable and useful works, which, if properly studied, will daily add much to your stock of information. Let me recommend to you an occasional revision of the text books, to freshen your mem- ory ; as these give new zest to your studies, and render miscellaneous works more pleasant. 22 There is one branch of your profession, which, forming the basis, claims your particular revision at least once a year—and that is anatomy ; this should be reviewed by a resort to the knife, when practicable. I often hear young gentlemen make the resolution to dissect one subject every year after they have graduated ; and I do not hazard much in asserting, that not one in twenty, who graduate, ever use the scalpel after they have left the walls of the college. I need not mention how culpable they are for this neglect, for you are all aware of its importance. I need not remind you how unfit you become, after a few years, to pursue a profession of so much responsibility, in which you have to operate on a machine, the construction of which, if you even knew it ever so well, you now have become almost ignorant of, for want of use. Let this enter, then, into your course of studies, ancl deem it not the least important of them. Besides the attention which I have advised you should devote to your mere professional studies, you should not neglect, entirely, general literature; this forms a material part of the education of every professional man. Without some knowledge of general literature, you prove but a dull and uninteresting companion to your unprofessional friends. Some portion of your time, then, should be de- voted to polite literature, to history, and to the understand- ing of the interests and institutions of your own country; and while you are in the pursuit of knowledge, and practise in your profession, be,ar in mind that a portion of your time should be set apart to holier pursuits. The study and practice of morality and religion become and are as much the duty of the professional man as any other in society. How consoling does it prove to a practitioner of physic, when he can conscientiously bend his knee at the bed- side of a dying patient, and ask aid from that source from which, at last, we only can have hope, to restore the sick, or smooth the path of the dying ; to ask a blessing on 23 our remedies, or, in the language of a celebrated profes- sor : " When the vegetable, animal, and mineral kingdoms have failed, appeal to the Author of all good, the high and mighty God; and when with his will they have failed to cure or alleviate pain, to implore him to take to his bosom the soul of our friend." Gentlemen, an awful responsibility rests on us when we are negligent of our religious duties. Where so much power is placed, and where so much benefit can arise from our exertions, we are highly culpable to neglect them. I must not be understood as asserting that our profession, as a profession, is destitute of this high and holy feeling: far from it, the popular opinion to the contrary notwithstand- ing. I here assert that there is as much pure, holy, and reli- gious feeling among its members, as is to be found in any other class of men. When I urge upon you the propriety of religion, I do not mean that outward show, that boasted parade of piety, which savors, at least, of hypocrisy more than of true religion. I mean a pure and more holy feeling; one that actuates you to be just and true in all your dealings ; to love your neighbor as yourself; to do unto others, as you would they should do unto you; to attend divine wor- ship, but not with the view of being called out in the height of the services, when the eyes of the whole congre- gation are upon you; nor to remain longer on your knees than any one else ; nor to make your responses louder than any one else; nor to wear the religion on your back, nor on your countenance: these are mere mockeries, and are deservedly denounced by the truly pious, as the off- spring of designing hypocrisy, and have given rise to the well-known assertion, that doctors become religious from mere interest.* Religion, such as I have represented it, is not incompatible with any duty of a physician; on the * It is said that the thee and thou of Dr. Fothergill, of London, was worth £2,000 per year to him. 24 contrary, it heightens the value of his character. Nor does it interfere with his social engagements; it only tempers them. No mind is capable of enduring continuously the pursuits and objects of a professional man. He, therefore, like other men, requires, when he is allowed to enjoy it, relaxation and ease. How should (I should rather say how can) a medical man enjoy relaxation? Men have dif- ferent methods of being amused. I can only say, that the way in which a medical man may abstract himself from his profession, must depend much on his peculiar taste. I shall only point out, in part, how he should not employ his time of relaxation. In the first place, he should avoid such pursuits as would interfere with his duties as a physician and a christian; and he should never enter so assiduously and earnestly into any unprofessional employ- ment, as to give him either a distaste for his profession, or cause him to resume its duties with a feeling of irksomeness. The great source of evil, in any pursuit of life, particularly of the young, is the social board; with its bewitching ef- fects it wins him from his studies, then from his patients, and lastly it weds him to itself. By its fascinations it soon entraps him, entwining itself around him, strangles and turns him adrift, conscious only of his own perfect and total wreck and destruction. This is an imperceptible effect ol the convivial life of youth; therefore avoid it. In the coun try another evil existed, at one time, which was equally destructive to the young medical man, as any other. It was the habit, arising out of the hospitality of the people, of inducing their professional friends to drink whenever they called, whether professionally or not. If cold, he was invited to drink to warm him. If warm, he drank to cool him, &c. And thus did the unconscious victim pass his days, till overtaken by a habit—a fixed habit—which left nothing of the once promising youth, but a wretched and miserable wreck. I have witnessed the effect of this cus- tom, when a boy; and was much disgusted when 1 saw the aged and once talented and respected doctor, who had 25 been sent for to visit a patient, taken from his horse to be sobered before he could prescribe. These are the two sources of ordinary indulgence in pleasure. At first, innocent pleasure; it leads you to the social board, or to visit your hospitable friends in the country; and in a few years it causes the once bright and promising doctor, the ornament of his circle, the courted and admired, to become a miserable outcast. But the dan- ger to youth from intemperance is daily becoming less. Thanks to the philanthropist of the present age, the march of temperance, like that of intellect, is keeping pace with experience and wisdom. The custom, once so rife, of treat- ing our friends, is now almost unknown. A drunkard is now rarely seen; the moral reform has made such rapid strides, that he who, but a few years since, was viewed as a hero—as an example worth imitating—is now not consid- ered a fit companion for gentlemen. A two-bottle man is now seldom heard of among gentlemen. May this prove a growing and a lasting effect of the efforts of the great cause of temperance. And it will as long as it can number among its advocates the ablest statesmen, divines, physi- cians, and lawyers, whose precepts as well as example are daily diffused, and held up to the community at large ; not confined to district or town, but extending far and wide, unconfined to country, to nation, or language. You have your part to perform in this great moral reform; and I feel assured that I shall not urge you in vain to contribute your share to the amelioration of suffering humanity—to lend your aid to the consummation of this great and de- sirable end. Having indicated the course of honorable and high- minded men of our profession, you will, no doubt, expect me to allude to that sometimes adopted and pursued by those who rely rather on their wits, than on a knowledge of their profession, to obtain practice. This subject has 4 26 been most ably handled, within a few years, by a Euro- pean physician of eminence; and if it were in my power, it would afford me pleasure to place his little work on medi- cal ethics,