C_HANN/N6r   (W)
OF THE MEDICAL PROFESSION, AND OF ITS PREPARATION.
AN
INTRODUCTORY LECTURE,
READ BEFORE THE
MEDICAL CLASS OE HARVARD  UNIVERSITY,
NOVEMBER  5, 1845.
BY WALTER CHANNING, M.D.
          BOSTON:
DAVID CLAPP, JR., 184 WASHINGTON STREET.
     Office of the Medical and Surgical Journal.
             1845. 
 
\ 
• >',i-

 
OF THE MEDICAL PROFESSION, AND OF ITS PREPARATION.
INTRODUCTORY LECTURE,
READ BEFORE THE
MEDICAL  CLASS  OE  HARVARD  UNIVERSITY,
NOVEMBER 5, 1845.
BY WALTER CHANNING, M.D.
           BOSTON:
DAVID CLAPP, JR., 184 WASHINGTON STREET.
      Office of the Medical and Surgical Journal.
              1845.
 
!
I
To the Medical Class attending the  Lectures in Harvard
                   University, 1845-6.

Gentlemen,
          I dedicate the following Lecture with great pleasure            ,
to  you for whose benefit it was delivered, and remain                    >
                      Your sincere  friend, &c.

                                          W. Channing.
  Boston,  Nov.  5,  1845.
 
LECTURE.
   The  professors in turn deliver the Introductory Lecture to the courses
given in this school.   It becomes in  time a matter of some difficulty and
thought to settle upon a subject for the annual discourse.   I must confess
I felt somewhat troubled by my election, or rather present rotation, to this
office. But very happily for me, just at the time, an advertisement in one
of the daily papers removed that portion of my embarrassment which the
choice of a subject involved.   The following is the notice referred  to.
                             " A PHYSICIAN
  " Whose character, as a man and a practitioner, entitles him  to respect and confi-
dence, would, it is believed, find a pleasant and eligible situation, in a delightful country
village, within a few miles of the sea-shore, where a vacancy has just occurred  (one of
the physicians having relinquished practice there).  A middlo-aged, married man, one
who has had experience in his profession, is well read, careful rather than scheming,
and of unquestioned integrity, and who can furnish good references, can ascertain
further particulars on application at this office."
   In this sentence, short  as it is, lies  wrapped up  much for the thought  of
him who is about to make preparation for medical  practice.  The world
over, the physician  in some  shape or other  is advertised for.   There  is
doubtless a  reason  for  this.   In Law and  Divinity nothing  of the kind
prevails.  The young clergyman is invited  to  settle, and the choice is
determined by the sectarian views he may hold.   The lawyer passes his
examination, enters the bar, and takes  his office in such  place as he may
be  eligible  to by his previous  education.   But the  physician may be
advertised for.  He reads the advertisement,  he  asks himself how  far his
qualifications correspond with the requirements, passes a favorable judgment,
and offers for the place.   Sometimes, not only his predecessor's patients
are in the market. His house and barn and land, his horse and sulky too,
are included  in the  " good will,"  and  so a  demand  is made  upon his
pocket as well as upon his mind.  I  have no information to offer in regard
to the results of such demands, and  of such supplies.  We may infer 
4
that  there  are  conveniences in the arrangements, or it is not likely they
would  be so frequently made.  In the notice placed at the head of this
lecture, specific qualifications are given.   The physician who would fill
such a place  must have  already filled some  other, and have done this ■
very acceptably too, for he must have built up  character there.  He must
have received  confidence, too, it  may be  a large one.  The age is pre-
scribed.  He must be married.   A William Hunter, or a John Haighton,
among the  foremost men of their age  as they  were, such men would not
have  met  the  demand.   He  must have vigorous  and well-cultivated
moral  and  intellectual powers.   He is to be well read; italicized ; and
careful rather than scheming, of unquestioned  integrity, and  is to  bring
vouchers for all these things, and some others.
   And now for what has this medical paragon done so much for himself
and for others  in the view of the advertisement ?  And to  what region is
he to be transported, if he accept the call ?   I do not  use the  word
technically, whither is  he to be  transported, should he accept the very
modest and very flattering invitation ?   I  quote the  answer, for  the ad-
vertisement has one.  Where ?  "A delightful country village, within a
few miles of the sea-shore, where  a  vacancy has recently occurred  (one
of the physicians having relinquished practice there)."   You see there is
no assurance whatever that he will ever get a patient \a that  " delightful
village."   O,  no.   He goes there to  fight that he  may reign.   He who
has recently  " relinquished  practice there" may have never had any,
but has lived in that wide domain of  hope, has enjoyed to  satiety that
lucus anon lucendo-ism, which are the occasional experience of the medical
man in other " delightful  villages  within a few miles of the sea-shore " ;
and in the  crowded city, too, though  built upon  " the beached verge of
the salt flood."  At least our advertisee will  find competitors who it seems
have too good a foot-hold voluntarily to quit, and who will hardly leave,
simply because somebody else has been invited to enter upon the  village
practice, and into their own proper labors.
   Let me, then, in view of the advertisement which is my subject, speak,
   First, of the Medical Profession.
   Second, of its Preparation.
   Let me  speak  of the  Physician—of his office—of his duties—of his
social  value.  He is in the market, let us  see what he is worth.

   Of the  Medical Profession  some judgment may be made, out of extra-
 professional opinions of physicians.   Cicero says of them, that in nothing
do men so nearly resemble the immortal gods  as  in giving health to men. 
5
In his Life of Dr. Garth, Johnson says, " I believe every man has found
in physicians great liberality and  dignity of sentiment, very prompt effu-
sions of beneficence, and willingness to exert a lucrative  art, where there
is no hope of lucre."   They were  palmy days of the profession when
these men lived.   In the age of the orator, medicine had not lost its con-
nection with the popular faith.   The hospital was a temple in  which
presided a god.  The votive tablet contained the  record of the patient's
case, and this  might be consulted 'by every  body.   The religion of the
time was  the  handmaid of medicine, and  the  physician was  held in
reverence by the people.   And  so  in some sort was  it with  him in the
time of the British  moralist.  The medical history  of  that day shows
that the profession was in  great honor.  The  physician had  an  impor-
tant place in society, in the literature  and the science of the time.  He
had public  and  private duties to  perform.   He  was a minister  of the
public health as well as a private  practitioner.   His education, his long
apprenticeship in the first place before he could be admitted to the lesser
places of the profession, his seven years noviciate in these before he could
reach  the highest, and  then  the severe examinations to which  he was
obliged to submit, before he  could enter these—the whole which  the age
demanded of its  public servants  established a claim to  the public confi-
dence  and respect which was generously allowed.   And  see to what indi-
vidual  excellence  and  greatness the requirements of the time  led, or
which they directly produced.   When has  medicine numbered so many,
and such names, among its members as then ?  When was the profession
held in deeper regard ?  That age has impressed  itself upon the succeed-
ing times.   The impulse then jjiven to the collateral sciences, as well as
to medicine itself, has never ceased to declare itself in the succeeding
history.   Chemistry, botany, comparative  anatomy, have each had a re-
gard, and from the best minds too, which ha*e placed them in the highest
ranks  of intellectual interests, and much which has  been done for each
and to all of them  in this way, has  been done by  physicians.  We can-
not look back  to  the time more particularly referred to  without being
struck with its moral and intellectual activity ; and do we not come from
our study with deep feelings of honor and gratitude that so much was then
done for  the  medical profession, and for  the  race.  We are no longer
surprised at the personal respect, too, which medical men received—how
much  their opinions  were valued, and  how widely useful  they made
themselves.  Johnson had a  special reason  for  the elevated  views he
entertained  for physicians.   He was the  man of  his age.   He exercised
an  extraordinary moral and  intellectual  power.   He  received  a  wide 
6
homage.   Our profession gave to him its very best care.   He had  the
willing service of its ablest members.   I say emphatically willing, and let
me add,/ree, too.  They literally gave him their time and their best skill.
They felt honored as well as happy to minister in all love and honor to
the physical infirmities  of one who  had given his life to his own time, to
its truest interests,  and  whose labors and name they knew were to  be the
inheritance of ages long to come.  Was  it not to  their great honor that
for such a man they so cheerfully worked ?  I always think of Heberden
as most worthy my respect,  when  I  see him  without " view to lucre "
giving his  noble endowments, his large skill, so freely, so  cheerfully to
such a man!  I honor my profession  that in its members it has cherished
such noble sentiments,  has manifested so noble a life.
   While thinking  of such facts in our professional  history, and  seeing in
them its true character, the civil position  of medical men, their relations
to the state as showed  by the public  distinction it bestows on them has
occurred to me.    In foreign countries, where titles of distinction are given
for distinguished  public  services,  upon medical  men,  and  the  same
is true of the greatest in literature  and science, titles of the most inferior
rank only are conferred, and as the social position they lead to, involves
no expensive outlays for  its  support, grants of money or of lands never
go with them.   The highest rank bestowed by royalty in Great Britain on
science and literature, is that of a Baronet. It is often only that of a Knight.
On the Continent, it is that of a  Baron, in  France the lowest, in Ger-
many so low that  it is  bestowed upon almost every body.  I do not refer
to this in the spirit of complaint.  It  certainly touches not us where the
distinction is  to have no title.   But  it is quite curious to observe the
scale of  estimation which prevails  where  titles are thought to be some-
thing  The highest title  to which a subject can reach, is  accessible to
the military man.   Nay  more, he may be placed quite near to the princes
of the blood royal, by the highest patent in the gift  of the  British con-
stitution.   The  clergyman may and does become  a Lord, a spiritual one
indeed, but having quite marvellous physical or political functions.  The
lawyer too not only may become Lord Chancellor, an  ex officio title ap-
pertaining to a certain  judicial position, and service, but how often out of
his profession are  peers created, transmitting their rank and their power to
their families.   Seventy  peerages have  been  created  from  the legal
profession.   Not  only are  such orders  of the  state ennobled, but  they
get from the power which ennobles them the  means to support their high
rank, and  these means, namely  money and lands, cannot be alienated  for
debt, or by will, but  descend too  with the title.   How different all this 
/
with literary and scientific men !   Newton, the light of his own age, and
of all times, was made Knight only as if in ridicule of his great* mission
to the world.   Davy had a barren sceptre put in his grasp, for he had no
son to'succeed to his poor nobility.  Scott, who filled the world with his
mind, and his fame—he who was not behind the chiefest of the apostles
of a  noble  literature—Scott  was honored  with the meagre  hand of a
parsimonious royalty, and in the changes of fortune which a trade in mind
involved, and  into which he felt he was obliged to  enter, more than his
life half spent, he was left by Crown and nation, to begin life  again, and
to force his  mind to accomplishments by which to pay his debts;  which
labor at length broke down  that which  did  it, and sent him to his grave.
What a noble work  was that!   How much  more than a whole dynasty
of kings ordinarily does !   Do you not  rejoice that it is impossible to re-
ward man for his best works ;  and that  the  state which does the most in
this  regard, does little more than to pay some reverence, do some honor
to itself!

   A profession is for life.   How  rarely  do men withdraw from a profes-
sion ?   It is not uncommon to find those who have passed middle life or
more, in other modes of using the rnind or the body, or both—it is not
rare to  find  such men who  have made themselves rich, leaving their
customary mode of life, and living, as it  is called, on  their means.   Not
so  with the  professional  man,  especially  the physician.  He  stands
steadily by that which in an earlier day stood by  him.   It has been to
him the means of moral and  intellectual growth.   It has given to him
consideration, a fair fame, honorable and  honored place among men.  It
has been to  him,  too, the  means of doing  good, much  good  to others.
Men have  come  to  rely upon him.  Moral and deep sympathies have
been established.  They have  passed from the parent to the child.  They
have been the legacies, the  transmitted memories of generations, and
have bound  hearts  and minds  together by  ties   which  infirmity or
death only  can sunder.   My observation  of medical men  extends to
nearly forty years.   I do not know an  instance of  a man whose whole
character and  position have been  the products of this profession who has
left his post.   I was  a member of a  committee who went to Salem to
invite the late Dr.  Holyoke to meet his professional  brethren of the State
on  his hundredth birth day, that  they might pay to  him personally  the
tribute of their large honor for his professional  excellence—their  deep reve-
rence for his unspotted life—their love of such child-like simplicity, such
surpassing moral beauty as were his.   We found him in his study reading. 
8
The work was a  volume of the  Transactions of the Royal Society of
England.   He received us with the  gentle  courtesy  of an earlier age.
He accepted  the  invitation, hardly thinking it worth  while for one, man,
and he so old, to give so many so   much trouble ; but expressing-Rimself
as much gratified  by what had been so kindly offered.  I said  to him
that we had interrupted his  reading, and asked  him  what  work it was
which  was so much  interesting him.   I shall never forget  his answer.
He named  the work  and went  on.  " O sir," said  he, " my memory
holds so little of what I now read, and that for so short a time, that books
of this day are constantly new to  me.  Scott's stories are always new."
But of early study and thought his mind retained most vivid impressions.
What,  however, is most relative to  my present point is this.  Dr. Holyoke
still belonged to his profession, and after his  100th year made a consulta-
tion visit with a friend from whom I  had  the anecdote.   I once  said to
Dr. Holbrook, of  Milton, then  an old man,  " Well, sir, I find you still at
work."   " O yes,"  said he, " I have  been in the fills fifty years, and shall
never get out of them."
   Now look where you will, this is the  universal language  of the pro-
fession.   Look  abroad.  Did  Dupuytren,  did Cooper, Sir Astley, did
any of the great lights of their own day, and which are to illuminate all
succeeding times, did they withdraw that light when it was most brilliant,
and put under a bushel what was for  the illumination not only of their
own house, but of the  world ?   No.   They were, without  a metaphor,
cities  set  on hills, which could not  be hid.  They  were  of immense
wealth.  They had fame enough and  to spare.  But they worked on.
They were unto death true to that  profession under whose generous influ-
ences they had become great.  Nothing could win them from that great
and early  love.   Come  home, and the same truth  is told.   Men here,
too, give to their profession, and to their age, their time and their mind.
Johnson said, a man, an old man   especially, should keep his friendships
in repair.   A professional man does this without  an  effort.  His works
follow him in his whole career, however long, and honor  him in his whole
course.   I have heard  physicians,  and those of much  eminence too, say,
that after such an  age, or under such and such circumstances, they would
retire from business. And an effort  to do so has been sometimes made. But
a lingering look has been cast behind.  The story of the tallow chandler
has been repeated in them.  He had  retired from business with a large
fortune, but he had made his  successor promise  to  send for him every
" melting  day."   Ho  could  not deny to himself the  exquisite pleasure
which that day for  so many years had given him, and from  which  all 
9
men out of his profession would have shrunk  with  disgust.  The physi-
cian does not forget " melting days."
   But a profession is not only for life.  It is  a life.  This is a fact  in its
history which should be brought with  most distinctness  before  his  mind
who  thinks  whether or no he will  enter upon its  study, or has already
done so.  What do I mean when 1 say a profession is a life ?  What is a
man ?  Terrence sees in  him the incarnation of humanity.  Homo sum
nihil humani a me alienum puto.  This should be the physician's motto.
Man to him is the embodiment of the moral nature, with the underlying
reason,  the living conscience,  and the directing will.   He sees in him too
the intellect,  the  understanding power, by which facts and  relations are
known, whose province is science  in  the widest  acceptation of the  word
—\vhiob sees in man a creator, the poet, one who pretends to solve the
problenrof the material universe, and enters  into the deeper mysteries of
the spiritual  being.   Now look  on man  as  we  may, in the study and
application of a profession his whole  nature is  in constant requisition.
Everything to the  physician  has regard  to  his  calling.   And what his
profession makes him re-acts upon  everything else.   Medicine in  its
immediate use applies to the individual.   It is that man, that woman, that
child, to whom it offers its  daily aid, and  for whose particular well being
it hourly seeks to provide.   But besides this individual office, it is no less
directly concerned  for  and with  masses of  men, communities, society.
The public health is  its care,  and so is the prolongation of life.   It  looks
into, nay it inquires deeply into that or those things which  reach in  their
morbid  influences  to the  masses of men.   The  sanitary  condition of
populous districts is its care.   Governments  come to it for light, and for
help, when the pestilence is upon the people, and cities are wasted, and
whole nations are well nigh made desolate.  Not only is  the physical
the  domain  of medicine.   It takes care of  the mind.  It studies  what
there is in social  and political institutions which reaches to and checks
the growth of man's  highest nature.  All questions of morals, of religion,
of politics  belong  to it.   It  looks  at labor,  the  noblest fact declared
by  human energy,  medicine  looks  at  labor, man's  work, and  studies
how it shall best  conduce  to  moral and intellectual  progress—when  it
begins to check this, and what are all  its agencies in  regard to physical
health.   Look at the late reports in England respecting labor in  all its
details,  reports made to committees  of Parliament  under the solemn
sanction of oaths, and learn what are the bearings of our profession  upon
the most important social and political  interests.  So  too does medicine
study what is poverty, its causes, its whole  effects upon  man  and  upon
                    2 
10
society, and declares its discoveries for the benefit of the people.  How
much has it done in one of  its departments for agriculture ?  In our own
day, chemistry, the peculiar study of the physician, is revolutionizing this
widest  field of human industry, and  bringing  into  every-day operation
principles which shall  be for the highest benefit of nations.   It were easy
to extend the inquiry and to show how comprehensive is medicine, how
truly is a profession a  life.
   I  had just closed this paragraph when I met with  the following illus-
tration of the sometimes silent  but constant agency of medical  inquiry
in benefiting communities.   In  England, opposite Liverpool, a new and
great city is in rapid  progress.   Ten years ago it contained 15,000 peo-
ple,  in ten more it will have  100,000.  I copy a paragraph or two which
bears upon my proposition.   " We feel the greatest pleasure in stating,"
says the writer,  " that, following the  improved sanitary views of  the last
few  years, they have made it one of their first cares to establish a  ' park,'
meaning thereby an open piece of ornamented ground for the future inhabi-
tants of the city."  * * * * " The space to be operated on was 160 acres.
Sixty being set apart for building purposes, there remain 120 to be laid out
in shrubberies, walks, and drives, for the enjoyment  of the  public  for-
ever."  Says the writer, " We  were  delighted  with what  we saw here;
but the satisfaction of the eye is nothing in  such a case ;  the  point really
to be rejoiced in is that the  ideas  of men  are now so far  advanced with
respect to the essentials of public health  and conveniency, that, in  pre-
paring a new city, a park for the use of the inhabitants should have been
among the first things provided for."  In this same city houses  for the
working classes are  in  preparation, each  having  three  rooms, gas and
water, for £5 or about $25 a year.   Burying grounds  are to be out of
the city ; as are  slaughter houses.   Everything shows in the building of
this new, this pattern  city, how rapid has been the  progress of our profes-
sion  in most important directions, preventions of disease—so making itself
less and  less important in the popular regard, by its wisest applications.
   I know that much that has now been said may meet  objections.   We
are told that he who  devotes himself to many  interests will  never have
wide success in any.   A  professional  man  must stick to his profession.
Ne sutor ultra crepidam, &c.  There is truth  in  this, but  not  all truth.
No profession is one study.   Medicine of all others is not.   It admits of,
nay it demands almost an infinite  variety  of mental  activity.   Look at
its lights, its great and honored men, and see  how in their  lives they
illustrated the quotation from Terrence.  Haller, a  high  priest in the vast
temple  of science, was  hardly  less  distinguished  for his physiological 
II
works, than for his moral, and literary, and philanthropic labors.  Hartley
was a physician, and who has done  more to solve that deepest mystery,
the nature of Man.  I remember being much  struck with an illustration
of the doctrine now  under notice, in the case of Dr. Brown, of Edin-
burgh, the successor of Dugald Stewart in the chair of ethical and intel-
lectual philosophy in the University.   I saw him as the daily practitioner
of medicine, as faithful to  its  duties  as  if he  had never done anything
else.  And look at that  other, of the same name, Sir Thomas Browne, who
left us a work on the Religion of the profession, which  placed him  among
the chiefest writers of  the Augustan age of English literature.  I might
easily  multiply instances.   1 was once speaking upon this subject, for it
has  long  occupied my thoughts—I was  speaking concerning it  with a
professional, a  medical man for whom I have sincere regard, and  who is
not without the public  confidence.   He thought a physician should be
nothing but  a medical practitioner, a daily visiter of the  sick.  " My
party," said  he, "settles the question  for  me of politics and  the  candi-
dates for my vote.  My clergyman does  the same thing for my religion.
I do nothing but practise, and my sole thought is how  that  may be best
done."  Now  if there be radical comprehensiveness, here is an  instance
of radical exclusiveness.  What  is  the  natural, I  do not say necessary,
tendency, of such  views  of professional  duty, or life ?  Is  it not daily
to contract more and more the sphere  of intellectual vision, until nothing
will be seen that is not  in nearest proximity to  the mind, until practical
professional life falls into that melancholy  routine which looks for nothing
better, since it can  tolerate no change ?
   I have sometimes thought that the want of intellectual activity, noticed
by some, in men of mechanical occupations, might be explained by their
devotion to some one mechanic art.  How little occasion for thought, how
little for conversation, in the every-day pursuit of some one labor.  Per-
fection is soon  reached.  The education is completed when the appren-
ticeship is over, and then, for life, what demand on  the individual remains
but a certain amount of physical power put forth  in the same direction,
with a settled  amount  of intellectual  effort, and a volition  so  slight  as
scarcely to be noticed.  If  we look for exceptions, such as are furnished
by such men as James Brindley, James Ferguson, and  James Watt, we
find even these men devoted  to the  business  or trade with which they
began life—Watt  developing  the  powers of  steam,  Ferguson  making
important discoveries in mechanics, and Brindley doing the same thing in
regard to the  mechanical  uses  of water.  And finally, we meet with
these very  persons  taking their honored place  in  history along  with that 
12
noble army of self-taught men who fill the chapter entitled the  " Pursuit
of Knowledge under Difficulties."
  Sometimes the profession  has  been regarded  as a luxury, and fashion
even  has  not unfrequently settled the question  of individual reputation.
Said Lady B. to Lord B. one morning, " the nurse tells me that the infant
has had a  bad night, and refuses  the breast."   " Send then for Sir H. H.
my dear.  By  the way, A, B, C, D, E, and F, will  dine  with me to-
day.  Tell Thomas to be sure to get a  salmon.  The Doctor likes sal-
mon,  ask  him."  " But, my dear, suppose there is  a division to-night,
and a call of the House, what can I do with this dinner party, and a child
so ill ? "   " Why Sir  H. H. will be here, and so the child  is  cared for,
you know, and then, I will put him in my  place at the table, and if they go
when I am called, why I save my champaign, you know."   Here is the
luxury of  the profession.  In itself how important is its office, for it takes
all the responsibility ;  and for collateral   capital, at  a pinch, how  much
may not be made out  of it.   But  it was  called fashionable, or it was
said that the physician may be amenable to this power in society.  Abroad
this is quite remarkable.  By or  through  fashion, men of not remarkable
powers or attainments, at least men who have done comparatively but little
to promote the true  progress of medicine, reach to the  highest present
fame, and distance all their  competitors.   The  extremes  of manner, of
address, of personal antagonisms, have determined the question of celebrity.
Sometimes a coarse exterior  and very rough  manner  have carried  the
point, while at others, the opposite have  been in the ascendant, or what
is more curious, men have lived  at  the same  time and in the same city,
as opposite to each  other  as possible, who have just divided the great
or fashionable world between them, leaving their  cotemporaries to stare at
such similarity of effect, from such diverse causes.   I could give illustra-
tions of this in the earlier medical history. They belong, too, to our own
day.   A  London physician has lately died  who belonged to the class of
high manners and high fashion, and, said  one of his  patients in a most ex-
traordinary and extravagant expression of regard for him, I would  have
sooner died under the treatment of Sir Harry, than  to  have recovered in
any other medical man's hands.   There  is  at this moment a practitioner
in London, not known hardly as having done anything for medical science,
or literature, who has been for some time, and still is, at the very head of
his profession, filled as it is  with  most distinguished  men,  and who has a
business so crowded as hardly to  leave him breathing time.  Turn from
this to such men as Sir Charles Bell, knighted as he  was, as a reward for
his noble  works for his calling, but who  died a pauper, living on  public 
13
charity, and whose family would now be beggared by its discontinuance.
Was not C. Bell a faithful cultivator of a field worthy such culture ? Did
not his earlier works on Anatomy and Surgery, and his  great and distin-
guishing one on the Nervous System, lying as it does at the very foundation
of a true pathology—did not  his  splendid work on the Anatomy of Ex-
pression, and that greater one the Bridgewater  Treatise—did not, I ask,
all these, and other unnamed works, speak daily to the fidelity of Charles
Bell to  his profession, and claim for him so much of public favor as would
have saved him from the  pension list  ?  There  are causes behind, and
which lie deeper than the fidelity adverted to—than the large endowment,
and its laborious cultivation—there are  causes besides  these  which often
do much to determine present  professional success.   I would inquire for
these, were I sure of getting an answer that would avail the student any-
thing.  They are  doubtless in the man, quite as strongly  marked as in
the society in  which  he lives.  He may be wholly unconscious of their
possession, and wonder at  his own success.   They may be such as an-
other might imitate, could he discover them.  They may be such as men
should,  and true men would shrink from, as from moral pollution !

   There is a moral quality of the  profession to which I will  for a moment
allude.   I mean its Cheerfulness.  Physicians are cheerful  men.   How
explained ?   The  moral faculties  are constantly in healthful  activity, and
the  same is true  of the mental.  A  physician  is  not  using his mind
directly, and constantly, in open competition with his brethren, as is the
merchant.   He is  not  in the market, and bringing into  hourly use  that
sagacity which shall result in the  best bargain.   He  is not as the lawyer
daily confronting others, and in the stern conflict of great argument labor-
ing for his client, and most  effectually doing so by the temporary destruc-
tion of those opposed to him, and the certain and continued destruction of
their client.  The medical profession is indeed  a warfare.  It daily fights
a great  battle.  But it does not contend for moral or intellectual  victory.
There  is no  money at stake.  The  physician's greatest  success  may
bring with it the least  pecuniary reward.   His success  has no necessary
relation with  money, or with fame.  Suffering, exquisite pain, is in his
path, and it is his office to remove it.  Death is before him, and it is his
mission to avert it.   He  sees life in  all  its aspects, its  darkest and  its
brightest.  Here is kindness which never faileth.   It sits by that bedside
by night, and  by day, and  with an angel's spirit  ministers  to that  ago-
nized frame which tosses there.   Here  is equal suffering, a deeper misery,
and  the tender mercies of those who minister  to  it,  are only  cruel. 
14
The profession is in  the public and private confidence after a manner in
which  no  other  one can  be.    Delinquency  in  all its  forms declares
itself to the  physician with " miraculous  organs."  Now  how active is
that soul which has its life in such duties.   How healthful is that activity
which has for its great occasion the removal of moral and physical disease
and misery.  How cheerful must  be that mind which has such duties, and
which are performed  with an undying faith in their own success.   And
success  is  their result.  Recovery from disease  is  the rule everywhere.
Death is the  exception.   The student of  medicine enters upon this pro-
fessional life because  of  the truth  of these  propositions.  He lives in, and
for, their verification.  The  profession  is cheerful because  it is healthful.
Its longevity  does  not equal  that of some other modes of life, but it is
still great.   Its health is the direct product of its physical exertion, its
exercise.   No matter how irregular  be the physician's habits.   He may
hardly have time for  eating, and none for sleeping.    He may be exposed
to all extremes  of temperature, be  drowned with the  rain, or choked
with the dust.  There he is abroad, facing the whole brunt of it, and his
escape from  what  such exposure might bring to other men, is  the conse-
quence of the fearlessness of his   life, of habit, of cheerful  submission to
the contingent, nay,  the inevitable.   Physicians are  often asked, when
the most malignant epidemics exist, and they are in the  very  midst and
pressure of them  night and day—physicians are asked  how they escape
in the general death ?  Is it not because of  the fearless, firm, nay cheer-
ful minds  and hearts which they carry with  them into the  sick  man's
chamber;  and because they go  there  on  the  highest  mission  which is
given to man ?   Is it not  to  the physical and  moral health, which the
whole preparation  for the profession, and its whole duties bring with them,
that the alleged  exemption  maybe  ascribed?   Men have fled from the
field of danger.   Physicians  fled from the Asiatic  cholera, that dreadful
disease, which Magendie said began with death.  But such men wore the
professional armor lightly.  They had not  its  spirit.  They quailed be-
fore the enemy.   They were not of us.   They  might have  died, had
they not fled.  Is  not the physician cheerful, too, because he is a tempe-
rate man,  finding  his pleasurable excitement in permanent stimulants, a
good conscience and  a noble  work ?  Is he not cheerful, because  he  is
not a speculator, in the business  use of the  word, and has no fear of a
fall in the funds, or in prices?   Is he  not cheerful because he has too
much occupation with the depressed and  the morbid in  others, to give
much time or thought to what he might hunt up in himself?
   However  it may  be in regard to  this quality of cheerfulness in the 
15
profession, do not let it  be for  a moment imagined by the student that
medicine is without its trials and its  sacrifices.   It has  both.  Its confi-
dence brings with it pain as often as pleasure.   Human nature is revealed
to the physician in  and by sickness, in  its weakness  as well as in its
strength.  The heart  here discovers its bitterness as  well as its joy, the
mind its  weakness as well  as its  strength.   Delinquency, the gravest
moral delinquency is among the revelations of  medicine.   At times  they
are  the conditions, the sole conditions, of a  true  treatment of disease.
But let me say here,  that whatever  our profession discovers to us of the
kind referred to, it  comes  to  us  as a medical fact which is never to be
disclosed.   Except  for the  defence of justice, in a  court of law, never
let the student suppose for a moment that what he is to be professionally
made acquainted with, is to be uttered by him, however  confidential he
may design his disclosures to be.  He is with  his patient, and before the
public, a physician only.   His mission  is to  treat disease, and to know
what disease is, he must be in possession  of all its causes.   This is the
limit of his professional relations, and let  him, as he loves justice, honor,
 and a true  fame, never, never in thought even, pass  beyond  it.   The
 limitations of our responsibleness, if such  we  have, will be considered in
that part of my lectures on Medical Jurisprudence which includes medical
 ethics.
   But the  confidence of medicine  does not  contain  all  the  trials of
 the physician.   His  profession  is a life.  It  has  not term time and va-
 cation, alternating in fixed order, as has  the Law.   It  is not with it as
 with the  mercantile life, " spring business, and fall business."   And it has
 not the privilege of the clerical calling.  " The Sunday dawns no sabbath
 day "  to the physician.  He is a minute man  in every sense of the  word.
 "Be  good enough,"  said one to me  one day, "just to sleep  with one
 eye open, we shall want you soon, and you know  there will then  be no
 time to lose."   " The doctor says  he  cannot  come !"  exclaims another,
 "he  is  eating  dinner!   What  business  has  a physician with dinner!
 Send  for somebody else."  " Confound that bell!" exclaimed a friend one
 day, " I believe it has at last learnt to ring of its own accord, and sets to
 always just as I get home ! "  Matthew  Baillie, physician extraordinary
 to the King, and author of the Morbid Anatomy, had  at the  close of a
 most  disagreeable winter's day, got  home from  an unusually fatiguing
 day's work, and was in the comfortable process of warming himself before
 a most genial fire, preparatory to his  dinner.   The London dinner hour
 was then six.   Everything went well, and the doctor  had  experience of
 one of the  pleasures of the profession, complete rest  and true comfort 
16
after hard work.  It was a " fearful joy,"  for in the midst and pressure of
it, the street door bell rang, and the servant entered, saying, in his wonted
quiet  way, that Mr. Somebody, residing in a distant and obscure street,
wished the doctor to visit him immediately.  The  very manner of giving
the message seemed  offensive.   "Tell  him I won't,"  was the answer of
Baillie.   The servant shut the door  gently, and was slowly on the way
to give the answer.  He had gone but a step, when the bell-rope was in the
doctor's hand—it was pulled " with a  will," I assure you, and  the servant
retraced  his steps.   Dr. Baillie met  him at the  door.   " Tell John to
put the horses to, and drive the carriage round."  Now  I know not how
Dr. Baillie  became  king's  physician, and there  may be differences of
opinion touching the value of the Morbid  Anatomy, but  there can be but
one opinion held of his character, as illustrated by this anecdote.   We
feel  that  he was a man, a noble, a great  man,  and instinctively pay to
him the homage of our " large honor," and love the profession which by its
stern discipline, its daily trials, made such a man.   Now Baillie had known
the trials referred to, in  their diverse  forms.  Allied to the  Hunters, and
to Sir Everard  Home as he was, and having an excellent mind, and that
faithfully cultivated, it was not till he was  between 40 and 50 that a just
estimate  of him had  been  made.   His business was   small  till after
that time.  But you see  the heart-sickness of hope deferred, if he  ever
felt it, had not soured him.   He did  not come into full  practice, public,
nay regal confidence, bringing with him  a cherished sentiment of ill-will
toward society, or  a soured temper, out  of that  earlier neglect.  No.
He came  with his moral and  intellectual natures not in  antagonism,  but
in perfect harmony.   The physical might in its weariness and weakness
disturb the balance, as in that answer to the poor man's messenger.   But
it was only for a moment.   And with  what exalted  dignity, with what
celestial brightness, may I not say ? did the man, the divine in him, in a
moment declare itself!  It were easy  to cite  instances  of a  like conquest
of the profession where there were  many  circumstances  to produce very
different  results.  I have preferred to  find  an illustration  of one  form of
sacrifice which it demands, in a fact out of a distinguished and great life.
   But trials and sacrifices are not only or principally  physical in their
nature, as are those just hinted at.   The mind  and the heart, too, have
now and then stern demands made upon them, and which they are forced
to meet.

   A topic remains, which I approach  with misgiving, but which has too
near a bearing on our subject to be passed by without  notice.   I refer to 
17
the present state of the profession in regard to the public estimation of it.
By some this is not thought to be  what it  once was.   We are told that
the ancient reverence in which  medicine  was held, is decayed, and that
the public confidence in it is  lessened.  Whence this opinion ?   What
are its causes ?   If it be in the position of the  profession at the present
day, that the altered sentiment has  place, what has produced the state ?
   The causes may  be general, and  special.   In the  first, we find  the
time  in  which we  live.    It is an  age of thought, of speculation, of
dissatisfaction with the present, of change.   It is an age of reform, a word
unmusical to many  ears.   The  power of mere, naked authority, quails in
such an age, to the demand made on all sides that it make clear its claim
to respect, to  defend  itself against the aspiration,  the hope for  better
things.  The past is summoned, is made to take its place by the side  of the
present, and to show cause why its authority may not be questioned, and
abrogated.   We may see  the illustration and  proof of the ground here
taken, in the diminished authority of the church, as declared by the  failing
power of creeds over the general mind.  It is very striking in legislation, as
showed jn the altered aud milder character of law.  A professional proof of
this  may be found  in the  view  taken of Sir James Graham's " Medical
Bill,"  which has been so long so  burdensome  to the British Parliament,
and  which  proposes  to increase the penalties for irregular practice, and to
give back to medicine its old authority in the state, by the  power of law.
One  of the most conservative  Journals in Great  Britain, the  London
Quarterly Review, open before me, has a sentence  which is conclusive
concerning this matter of increasing  penalties  against  irregular medical
practice.  It occurs in a  review of Sir James Graham's Bill.    " It is
needless to discuss the question whether the legislature  ought to interfere on
such occasions, when it must be  plain to every one that it is impossible for
them to do so, and that the most stringent statute  having this  object in
view would  be  from  the beginning a mere  dead letter.   Napoleon's Ber-
lin and Milan decrees could not prevent English manufactures from find-
ing their way to the Continent; and the instinct which leads us to struggle
for the  preservation  of life is a more  powerful  agent  than  the desire to
have the best calico and cutlery."
   A society in  London, deeply interested in the suppression of the slave
trade, has recently petitioned Parliament to have the naval force withdrawn
from the African coast, as  it has  been ascertained  that its presence  in-
creases  the  dexterity and  vigilance of  the slaver, and  adds  more  power
and  success to the piracy.
   Within a very  few years the Medical Society of this  State surrendered
                      3 
18
 the law which in intended kindness to the profession gave to its members
 exclusive power to collect its  debts  for  professional  services.   In these
 and  similar  facts which distinguish   the  age,  I  look  for some  of the
 causes which, as  has been  alleged, may have  diminished the public au-
 thority of medicine.   But others have acted more directly.   The effort
 has of late been to make  medicine popular, to  unfold its  mysteries, and
 unconsciously to make every man, woman, and child too, his, her, or its
 own doctor.  In this work, medical men, educated physicians, have en-
 tered as freely almost  as  has the more interested quack.   And how ?
 Look at the popular  education.   The schools  are filled with  books on
 anatomy, physiology,  hygiene,  physical education,  chemistry, botany,
 and what not, prepared with great care to teach these  several branches
 of medicine.   We have popular lecturers,  men  and women, who give
 regular courses on  anatomy,  and physiology,  and means of preserving
 health.   Yes, we have it advertised in large letters,  on large bills, that
 Dr.-----will lecture on such evenings to men alone on  matters which it
 behoves them to  be anatomically, physiologically, and pathologically in-
 formed about—and on such evenings to women alone on kindred matters
 of interest to  them.   The  female lecturers judiciously  confine themselves
 to the peculiarities of their own sex.
    Now look  about fifty years back.   See how  these matters then stood.
 We  had  indeed  Willich  and Buchan, but  they were  not  then parlor
 books.   We had anatomical  lectures in the medical colleges,  but we did
 not make anatomy a tea-table  topic.   To wear a false tooth  was made a
 question  of morality, since it was considered a  mode of obtaining goods
 under false  pretences.  And  dyspepsia  was eschewed from the common
 talk, as it involved particulars which might not be discussed to ears polite.
 Now teeth are talked about, a3 is the weather.   Dentists have their friends,
 almost their parties.  Men have bowels, loose, or  costive, and women have
 spines of the back.  Is it at  all to be  wondered at that medicine, whose
 mysteries were once so sacred as  to dwell in temples, whose  words were
 oracles, and whose deeds were of the gods, and which at  a later date was
 so far removed from the public stare—is it to be wondered at that medicine
 should have lost something of its earlier veneration, now that it is taught in
 the nursery, and lies so naked upon the very surface of society ?  If there
 be  truth in all this, what is  the duty of the student in regard  to it?   His
 duty here, as in  regard  to  the whole  profession, is to make perfect pre-
 paration for what  he will be called on to do ;  and in regard to the public,
always to  labor for its  highest present good, and  to secure to  the utmost
of his power what good he  may now do, to  both his profession, and to 
19
 the public, for all succeeding times.   Never let  him condescend  to min-
 ister to  a  depraved  public  taste ; but ever seek  the true dignity of his
 calling by contributing to its certain advancement.
    Other causes have wrought to a like end with those  named, and they
 deserve more special notice.
    First,  the popular  literature of  the  profession.  What is  this?   It
 consists in works  on the diseases of children,  of females, of mothers,
 on  the  management  of  consumption,  &,c.   They  are written  by
 physicians,  have  glossaries  for explaining medical  terms, descriptions
 or definitions  of  diseases,  with  recipes  in  English   to  suit.  These
 works profess to be addressed to  the profession  as well  as to the public.
 To the  former  they are utterly useless  if the  profession  be duly edu-
 cated.   To the latter they  must be worse than useless, seeing that the
 public  in  this  regard, and  for  such purpose,  is  not  educated  at  all.
 These works are designed to  show what should be done  in slight diseases,
 or in the beginnings of the graver, and which beginnings are for the most
 part, as the physician knows, but the incipient movements of the gravest.
 And to  whom are they to  show this ?  To mothers, and  nursery maids,
 since the man of the house has nothing to do with this domestic literature,
 unless to take a prescription now  and then from  the powers above stairs.
 In other words, these popular works suppose  that the persons referred to
 understand the distinction between diseases, the  diagnosis ; and the dis-
 ease given, they have only to  turn to  the treatment.  Nothing to my mind
 is more absurd and injurious than all  this.  The physician is to be sent for
 if things grow worse.  The parties  do not commonly know if this  be  the
 case ; and if they do,  they will not  probably send for the physician  till
 his office is useless, or  if not, not until the case  has  become  so compli-
 cated by what has been done, that it is by no means easy to  say what
 may be  safely done next..
   I would not exaggerate the trouble or the harm produced by the books
in question.  I think it  unworthy the profession, and unjust to the  public,
to scatter in its paths books  which cannot be understood  by it, and which
in place of producing knowledge, is only giving injurious activity to igno-
rance.  There is less to my mind to complain  of in the veriest works of
the most unprincipled  quackery, than in  these which  come  from  the
regular faculty.   They often  place it  below the  most unqualified empiri-
cism.  What can be more annoying than  to be met at the chamber door
of a patient by  a friend, a female friend,  with book in  hand, welcoming
us by reading the history of the disease, and then telling us of remedies
and results, adding  that calomel  and bleeding were  now  necessary, but 
20
she really was unwilling to meddle with  mineral  poisons, or  with edged
tools.  He who may consult with such a practitioner violates a law of the
Medical Society of this State, and exposes himself to its severest penalties.
   Turn now from these popular lights, and very popular medical guides,
to another portion of popular medical history, that we may know more of
the causes which may have affected the good  name of medicine, or given
rise to the opinion under consideration.   I  refer to  the daily forthcoming
new doctrines of disease, and  the  no less new methods  for their treat-
ment.  Why do men, and women, and children, die  now-a-days?   The
hydropathist tells you the physician kills them.  The homceopathist, that
it  is allopathy which daily slays its  thousands.  The  mesmeric  seer
ascribes the bill of mortality to neglect  of mesmeric  medicines—and the
Anglo-Saxon medicine-man, with his white skin, says  faith only is wanted
in the Great  Spirit.   The  world  is full of sure means of an  earthly im-
mortality, and still men die.   I refer here to a portion  of the  medical
history of the  day,  and if measured by  numbers,  an  important  one.
These  are among the  modern contrivances  by which men seek to live
themselves, and to make  live others.  And  who  sustain  them  in  their
Legion numbers ?  I answer, men for whose judgment, in  other matters,
we have  respect.  They have advocates, women as well as men, of rank,
of wealth, and of talent.  I remember when there  was a  little secresy in
this matter.   But none exists now ; and men and their large connections,
give in their allegiance to some new system.   They have for it the strong
attachment which deserters from the old, and advocates for the new,
generally  have.  They are jealous for their system,  and  the regular
should  be cautious lest in questioning their faith, he spring a mine which
may bury himself.  Elliotson, so widely known for his writings, a professor
in the London University, and  a hospital  physician  of established  cha-
racter—Elliotson  sacrificed both, and more, to his conversion  to mes-
merism.   It was nothing to prove to him  that  his mesmeric subjects had
wholly cheated him,  that they were utterly abandoned in  character, and
so wholly unworthy his confidence.  He kept the faith. How easy were it
to furnish here illustrations  of the power  of hydropathy and  of  homoeo-
pathy over minds which in  regard to other subjects claim our respect, and
from whom we cannot withhold it.
   How have these things diminished public confidence in  the  profession ?
   First, by withdrawing from it the active patronage of men whose favor
was to be desired.  This, however, I regard as the least of the agencies
which have injuriously reached our profession.   I think indirect influences
have done much more.  Among these I rank the manner in which new doc- 
21
trines have been met by medical men, and especially that in which it has
been  proposed to treat  their professional advocates.   1 have  already
referred to what is now attempted to be done in England by the Medical
Bill  before Parliament.   It  is proposed in that Bill to prevent irregular
practice by law.   The same has been recently done in  some States at
home.  And what  I think still more injudicious, physicians have been ex-
pelled  from medical  societies because they have adopted some of the
new methods of practice.  The followers  of Hahnemann have in some
cases been  so treated.  I have no sympathy with  this doctrine ; and still
I would not deny  professional fellowship  to  those  who  have such sym-
pathy, who for years have  stood with  respect in the medical ranks, and
who have left  them for what they believe  either better for themselves, or
for the public, or for both.   I am free to say, however, that I think that
he who has made  a copartnership of the old  system with the new, and
who leaves it with sick men, women and children, to determine by which
mode to be treated,  has done  that which demands the utter  neglect,
if not the contempt, of the profession.
  And  how have these new  doctrines affected the profession through
those who  remain faithful  to  it ?   The opposition  which  they  en-
counter increases  the  interest  of their friends in their defence.   They
consider it an  interference with  their right  of judgment in matters  which
most nearly concern themselves.  The  early professional teaching of the
public above referred  to, the professional  class, and other popular books,
have made them judges,  and they will use their  knowledge.   The new
method is so simple that  a child  may understand it.   And the medicines
in some cases  are so minute in dose that they can do no harm. Their virtue
consists in the character  of  their agency,  this being as little  felt by the
sick, as by  the drugs themselves.  The domain of the transcendental be-
longs to the new doctrine, and he who has adopted  it,  has been, by that
act, made free  of  that limitless republic.   What  now can professional
opposition to all this do but strengthen  its power?   It brings itself into
comparison with it, and where  the  public  interest  enters into the judg-
ment, it is not difficult to see to which side it  will turn.
  A question  arises, should  not the  profession examine  pretensions  which
are at all sanctioned by the  time through  which  they  have  lived, or by
the numbers and characters  of those who  have supported or  do  support
them ?  Is it not due to the public, that those who  have long had its en-
tire confidence should so far guard its most important interests as to give
time and thought,  deep thought, to  that which threatens to  disturb it ?
May there not be some truth in the  new ?   Is it wise to believe, and prac- 
22
 tically to say, that there  is nothing more to learn  concerning medicine?
 Has any one of the new methods  been examined  on its  merits ?   Has it
 not been treated on its  earliest promulgation, with  contempt, as having
 no merits at all ?
   There is another fact in the  history of irregular practice, quackery so
 called, with which the student should early be  acquainted,  as explaining
 or accounting for some of its power.   It has been frequently resorted to
 when the regular practice  has withdrawn itself, or  declared  that it could
 do no more. And what is true in some such cases of irregular practice, the
 so judged incurable have sometimes recovered.   The expediency of an
 unqualified  prognosis has been questioned.   Said a distinguished medical
 lecturer once, " When I am asked,  in seemingly desperate cases, what my
 opinion concerning results is, I answer that  I have seen people apparently
 worse, recover; and those who seemed less ill, die."   He never forsook
 the sick nor dying.  Laennec and others had not given then their cases of
 recovery  from consumption,  but he sought  even  to cure consumption.
 This medical faith  in that professor secured to him the confidence of the
 sick, and so all  that the mind can do towards cure  was on his side.
   I have met with a passage in a work, out of the  profession indeed, but
 which bears so directly on our subject, that I  am induced to transcribe it
 here.   It is of great value to the student.
   " We have no inclination, and  certainly we have  no inducement, to
 under-estimate the importance and  usefulness  of the  medical profession.
 We know that through its  agency life is prolonged, bodily sufferings are
 mitigated, mental anxieties are  removed, and that the benefits which it
 confers are not confined to the individuals principally concerned, but  that
 they often extend to whole families  who are dependent  on them for their
 worldly prosperity and happiness.   We  know that there  is  scarcely  one
 hour in the  day  in which  a judicious and well-informed practitioner may
 not say with a safe conscience, < I  have  done good to somebody.'   Still
 the medical  profession cannot do all that is expected or required.   Sooner
or later, and with every one among us, the time arrives  when the  best
 medical aid, as it regards the preservation of life, is good for  nothing.   It
 is  true that,  even under these  circumstances, it may often diminish pain,
or alleviate  such bodily distress as is not improbably  worse than pain :
but not unfrequently even these objects are  unattainable  ; and the most
skilful and experienced person standing by the patient's bedside feels  that
his wand is  broken, and that he  has nothing left to offer but his sympathy
and commiseration.  But the desire of life is not necessarily  extinguished
even in the hour of death; or if it  be so  with the patient himself, it may 
23
 still  linger with his family and friends.   When the  art  of the  regular
 practitioner can do no more, are we to be  surprised  that the  promises of
 others should not be  wholly disregarded ?  and that  even the miserable
 chance afforded by the impostors of the day should be looked at with some-
 thing like hope when  no other chance is  left?   It may be said  that to
 catch at such a straw  as this  can only end  in  disappointment; but the
 reflection that any plan, however in itself absurd, has not been tried, may
 cause disappointment  also."  London Quart. Review.

   But whatever be the popular estimation of medicine, there is one fact
 in its history which challenges for it the highest public confidence.  I refer
 to the progress  which it has made,  within a few years, and which it is
 daily making.   In this fact do we not find good  cause  for congratulation ?
 By new modes of investigating disease, a better assurance of the truth of
 facts, their more strict and philosophical analysis, a wiser and wider ob-
 servation,  these and kindred agencies  have distinguished our professional
 times, and contributed truly to the progress of medicine. The numerical
 method, which though by some is  nothing but  counting, and what" more
 is it ? has  done excellent service.   It has done something to determine
 the frequency, and character of disease as  far as it  is applicable, and
 made sure what was formerly  so  unsettled.  A man who has any due
 sense of character must count now-a-days.   ft will not do  for one to say
 he has cured  consumption very frequently, in  questionless  cases.  He
 must add up his numbers.  He must tell us what the precise number is.
   But the numerical method, counting as it is, demands much more than
 simple addition.  You must know what you  count, and you must furnish
 the proof that you are right.  The medical witness must not only be of
 unquestioned veracity.  He must have knowledge, exact knowledge, or
 his testimony will be worthless.   His  reports will have equal value with
 the story of the three black  crows, which turned out  no crows at all'.
 The illustrious Louis, and his great predecessors and contemporaries, have
 established the  paramount  importance of  diagnosis, or the distinction of
 diseases.   Nay, he and they have extended  their severe methods of in-
 vestigation to the agency of particular  medicines or remedial methods of
 treating disease.  Bouillaud has told us exactly the number of cases of
 rheumatism in which he has used bloodletting.  Its quantities, its immediate
 and remoter  effects  are given, and  so we  have  learnt when and how. it
 may be  best resorted to.   A very important  result of  the later methods
has been the  reduction  of the types of disease, by finding in a single
 type the paternity of a whole  pathological  family.   Philosophy  delights 
24
in the fewest causes for the  explanation  of its phenomena.  Gravitation
solves  the problem  of the  motions of the universe.   Medicine is daily
approaching its highest philosophy ;  and who  knows but that  it may, in
its progress, make itself unnecessary, by disease being resolved into a unit,
and its treatment into a single method.   In another way has professional
progress usefully affected  the  popular view of medicine.   Less and less
reliance is placed in the very active treatment, the heroic medicine of an
earlier day.   How much  easier, it is asked, is disease treated—how little
comparatively is done for  it—won't you do more in this case ?—where is
calomel ?—where is bleeding ?   So  questions come.   But the physician
pursues his  plan.  Disease  is shorter.   Suffering is less.  Recovery is
more certain.   In our enumeration  of causes  which have relieved medi-
cine of much of its popular mystery, increased longevity,  the result of a
better  hygiene,  and the  diminution  of malignant  diseases or of  their
power to shorten life, should not be forgotten.   I might here mention the
diminished mortality  from smallpox,  and the  great deduction from its
whole  morbid  power  by  the substitution of  vaccination.  And  so of
syphilis.   What change and improvement have  been made in the treat-
ment of this disease, and how much have  its destructive  agencies been
controlled, and  its injurious results been obviated ?
   While the progress of the profession may, as alleged,  for the time, have
given  power to  that which opposes  its interests, let it never be forgotten
that the physician who deserves  public  confidence is now as sure of it as
he ever was.  If the public look for a more excellent way in  a practice
in which its own opinions  are taken, its adhesion to such practice will be
pretty sure to fall away when such opinion ceases to be cherished, or to
be consulted.   In other words, in the time of danger the highest authority
will be demanded,  and he or she who for a time has yielded to the fas-
cinations of the new, will surely seek safety in  the old, and the tried.   The
only power of our calling is in its true knowledge, and never in its  history
have the means of such knowledge been  in fuller measure, or wiser ope-
ration.   It is for the physician to secure the whole benefit of such power
to the public,  and to  his  profession.   It  is the paramount duty  of the
student to make such power his  own.
   I have thus spoken of medicine as a profession, as a life, as a profession
for life.   We have seen it having  intimate connections  with all the  great
interests of life.  We have  learnt  what are its demands  upon him who
has devoted  himself to its stern service.  It demands  the exertion of all
his powers.   It calls into  exercise the whole moral, intellectual, and phy-
sical.   I enumerate the last, since surgery is one of its  departments, and, 
25
as the word imports, is " handwork."  It asks for the highest cultivation
of the senses.   The eye is its servant in observing external diseases, and
with these all  those  changes, of expression  and manner which come
under its notice, the  whole  physiognomy of disease.  The ear is called
upon as the instrument for detecting diseases of the chest, the respiratory
sounds  in all their varieties,  and  those communicated by the heart.
Touch,  taste, and smell,  are all in requisition.
   Let  it  be  remembered, then,  by the  student, that medicine  is not a
dogma,  nor has  it  its  reputation  in an age, or  in a name.  It is, in its
principles, the great,  the sublime generalization of an infinite  number
and variety of facts, the  observation  and collection of which, beginning
with the priest-physicians of Egypt, have been continued to us  through
the heroic medicine of Greece—by the votive tablets  in  the temples of
iEsculapius—by the depository of all earlier learning, Arabia—by Rome
—and through all the succeeding times.   The principles of medicine are
the inductions from  every fact which its disciples  have seen, studied and
recorded.  To us, this day, it  is  philosophical criticism, examining and
propounding  the character of all medical doctrine.   It  is philosophical
classification, giving permanent place to, and establishing the relations of,
all  facts.  It  is  scientific nomenclature, giving expression  to  them all.
A man  to have true influence in  such  a profession, must then  have true
knowledge.   He must know  many things, as well  as the mass of men
knows them.   He must know some, are they not many ? better than any-
body else.  A great  man here, makes great, that to which he  has given
his heart, his hand, his  mind.  His labor becomes worthy of his whole
power   and  being,   by  the  transfusion  into it  of  a noble  spirit.  It
has then in it, emphatically, him  whose it is.   He is its present life, and
its present honor ; and in his  own immortality, it becomes itself  immortal.
   Now in what consists  preparation for such a profession ?  What is he
to do who has this day begun its  study, and  who has devoted himself in
that act to the highest service of  man, who  means to live in the  present,
and has in that purpose the prophecy of living in the ages to come ?  A
German writer of wide  fame has left a work on the " Vocation  of the
Scholar."  What is the  vocation, the calling, of the physician ?   I have
answered  the question, imperfectly indeed,  in  the views offered  of the
nature and demands of the profession,  and shall proceed at once to speak
of the   preparation  required  of the student by its duties.   I enter here
upon no light work.  Is  it not the  most important which can occupy the
mind—how another mind shall be  trained,  or may  train itself so as to
bring out into full life its  whole powers, and  in  doing so render  the truest
service to the race ?
                      4 
26
   Says Locke, he who would  obtain truth, must begin with the  love of
 it.  We profess to  study, or to search for truth,  in all  intellectual and
 moral effort.   Is there any pursuit which has for its object more important
 truth, and in which the difficulty to obtain it is  greater, than medicine?
 Let him who has, or is about to devote himself to it, begin with a love for
 it.  The preparation for its  practice is in time, and in its employment.  I
 do not ask here how much  time it may be necessary for each one to de-
 vote to the study of medicine.   I  know not, and who does, certainly
 does he not who is making  preparation for active life, how much time is
 demanded to make It perfect.  And yet for a moment let us see what are
 the  official arrangements  in this matter.  The length  of time a stu-
 dent shall  devote to this preparation varies in  different countries, and in
 different  parts  of the same  country.   What answers  very well in one
 State in this Union, will not  answer in another.   In one, if a student be
 a graduate in a college, two  years of medical study is thought sufficient.
 In most, if not in  all  others, three years are required.   But where this
 is the case, in some schools, if  the  student  have  attended two courses of
 lectures, though  one course  follows directly upon the other, he  may be
 admitted long before the three years expire ; and a President of a  Col-
 lege once said to me, in a correspondence on  this  very subject, that he
 thought if a student could  pass an  examination   after  two  years  or
 more of study, he was  quite as  deserving  of a  degree as  was  he who
 required many years for the same preparation.   Then, again, the length of
 lecture  terms.  This differs.   In one school it is thirteen weeks, in  another
 seventeen.  The number of teachers greatly differs, in some being six, or
 even eight,  in others three or four.   In  many schools professors are  non-
 resident, but supply two or more schools in succession.  In order to do
 this, the same professor gives two or three lectures a-day,  sometimes two
 in successive hours, so that  he does up his teaching in five or six weeks.
 He then examines the candidates for  the  degree in his department, and
 of course  without any knowledge of their  appearance in the others, he
 leaves a vote for or against, just as he  appears in  his own.   Then again
 in regard to hospitals.  In some schools they form a part, is it not almost
 the most important part, of preparation ?—in others  they form no part of
 it at all.  Where they do, the pupil sees  the  sick with his own eyes—
witnesses the mode of examining cases by skilful, able  men—hears  the
order and kind  of symptoms—knows what the treatment is, and sees the
result.   At  the clinical  lectures, both  in surgery and in medicine, he is
taught,  thoroughly taught, disease in its immediate illustration, and if he
have man  in him, knows what his duty is, and performs it in this highest
regard, he goes home, or into practical life, with true preparation for his du- 
27
ties.  Suppose he passes his years of study in a city where is a hospital,
and  diligently visits it.  So much better  is  his preparation.  So much
better his claim to the public confidence and respect.  See now, for you
may, what is a medical education  without such means of knowledge.
   Medical Schools, however, do  not  only give  authority to  practice.
Medical  Societies do the same.   These require three years  of study, k
may be.   They  prescribe a  certain  course of reading, the same for all,
and demand a good moral  character.   But they demand  no courses of
lectures and no hospital attendance.  Like the Schools they require satis-
factory examinations.  What a variety  in requirement!  How compara-
tively full, how positively deficient.  Does not the question almost arise,
if in such confusion, and so much imperfection, if true means of prepara-
tion exist at all ?
   Abroad much  of the same thing  exists.  But  the  division of labor
there, secures comparatively ample time for the separate  study of each
department.   Surgery makes an independent study, though the principles
of medicine make  part, and its  practice in  many cases  obtain.   So does
medicine, that being  more exclusive, the  physician never being acting
surgeon.   The division is deeper than this.   The eyes, ears, toes, tendons
and teeth, have  special study.   Midwifery in some sort exists alone.
Now in  such an arrangement, the time of study abroad, the apprenticeship,
the hospital, lectures, apothecary's shop, &,c, all go to make the student
accomplished  in  his art.   The  examination is a  severe  one  in  all the
colleoes  for degree, license or fellowship.   And the chance is  the public
is well   served.  The  general  practitioner, so  called in England,  he
who combines in  himself many or all  departments, has recently excited
much public and legislative  interest in regard to preparation and qualifi-
cation, and the Bill in Parliament, before  referred to, has these matters
specially in view.
   Now  here  we are, all of  us,  general  practitioners.   Our two, or at
most three years study, which taking out sickness, vacations, amusements,
may be  reduced  one third  or  more—with lectures or  without—with
hospital  or with  none—with old books, or with new—selected  by the
teacher,  or not selected at all, or by the student himself—these constitute
the variety of means of our  preparation for entering a profession distin-
guished  by the number of its departments, its diverse interests, its grave
responsibilities.   The subject occupies deeper regard every  day, and every
year.  Abroad it is a topic of intense interest.  In America men are con-
stantly directing to it the attention of the profession. I have before me now
a circular calling for a Convention of Physicians who shall take the sub- 
28
ject of professional education into deep  thought and propose measures of
 reform.  We have seen how  different are  the requirements of different
 schools for the same  degree, or license to practice.  What  is equally
 worthy notice is the fact that in every school each student is to  be equally
 taught in the same  time.  The amount required therefore  of each, can
 with justice be only that which  he who has the least or an average power of
 acquisition, may learn, and so the highest knowledge may not be present-
 ed as an object of general or  individual attainment.   The examinations
 may not meet the  whole difficulty of the case, and an inferior  standard
 of qualification come to be established.  The same remark, it may be said,
 applies to all other education, that of  the university  for instance.  And so
 it does.  But the  demand  for something higher in a profession is found
 in the fact  that this is to fit a man for practical, responsible life.   The col-
 lege study  is but a step on the way to that life.   The public has a right
 to the highest qualification for the highest duties to which any of its mem-
 bers may devote themselves.   Especially may it demand that  the prepa-
 ration shall be ample, if not perfect—that there shall be fitting knowledge
 acquired, if not all knowledge.

   What shall be studied ? I received a letter, a few days ago, asking what
course of previous reading this  school required for attendance  on its lec-
tures, and what  course it prescribed  during the  lecture session.   I was
 glad of the request, for it allows me to say something of a very important
subject.  What shall the student read ?   " Action, action, action," said
 Demosthenes—and  " Coke, Coke,  Coke,"  might  have  said one  of
the most distinguished jurists in  English history, Lord Eldon, for in Action
was the secret of true eloquence with the Greek orator, and Coke's Com-
 mentaries on Lord Littleton was English law to Lord Chancellor Eldon.
But again, what shall the medical student read ?   Blackmore,  afterwards
 Sir Richard of that name, and a distinguished physician, and  a  very volu-
minous poet, being about to  begin  the  study  of physic, went to Syden-
ham one day, and having told him his purpose, asked him  what  book he
had best read.  " Don  Quixotte," answered the English  Hippocrates.
I do not stop here  to ask what was there  in  the case of the applicant
which led to the singular advice of Sydenham.   I will at once  point out
such a method of study as observation, and such  works as I have consult-
ed, seem to me most strongly to recommend.   I shall speak of Time, and
of its Employment.
   Let then the first 18 months be devoted to anatomy, human and compara-
tive, chemistry, botany, mineralogy and geology.   Let the student attend 
29
lectures on the above branches, and these only.  Let him visit a hospital, but
devote his attention mainly to the observation of external diseases, surgical
for instance, and diseases of the skin.   While attending lectures let him dis-
sect, and if possible become an assistant in the chemical laboratory.  In these
studies, especially in anatomy, lie the foundation of medicine. No physician
can safely want the  knowledge of them.   No one can be an accomplish-
ed, thoroughly educated physician  without them.   They have been the
studies of the most eminent  physicians of all times.  Chemistry has had
its birth and  growth in  our  profession.   It has now its place among the
exact sciences, and  has its methods  from  the most profound and severe of
them all.  In its investigations of the organic, and the inorganic, it occu-
pies the widest space  in the field  of science.   It is full of interest.  It
has been loved with a devotion  which no other branch of medicine has
reached.   No one can  be a true  scholar  in this profession without a pro-
found knowledge of its principles, and of their detailed practical applica-
tions.   The  other studies  enumerated  possess  great interest.   What of
disease was  named  addresses  the mind  through the senses.   These last
acquire their  best cultivation in this way, and also by those portions of natu-
ral history which were  stated to  be indispensable to the medical scholar,
for themselves, and  for the important aid which they bring to  the studies
and practice, of the whole profession.
   I have omitted a  study which  may well come in, in the first 18 months,
the History of Medicine.   A student should early know something of the
progress of that pursuit to which  he has devoted his life.   He learns how
so much of time, so  many ages, have been filled by his calling.  He begins
with his mind as much wanting  in  knowledge  of the matter,  as was the
time in which it has been brought to light.  He begins with the earliest,
the fabulous  periods of medicine.   He travels through its ages, noting who
have marked  them, and by what  they  have  distinguished them.  He
knows little or nothing of the doctrines, or of the practice which pass be-
fore him, for it is not literary history he is studying.  And for his purpose
he does not  want such knowledge.  He is filling  his mind with chrono-
logical epochs, with distinguished  names, and  with individual mind and
character.  He is a witness of struggle, of defeat, of  victory.  Insensi-
bly his  own mind becomes awake and alive to the fact that the profession
to which  he has devoted his  life  is  worthy the devotion.   He insensibly
takes his  own place, or feels that  he has one  to take, in the long and
venerable history of a noble art—of an art which has  occupied  great
minds,  undergone  mighty revolutions,  but which  in  every  day of its
being  has had for  its  purpose  true good to the  race.   Let him  then
study Le Clerc's History of Medicine, and Clifton's Hippocrates, the Life; 
30
Millar's Disquisitions in Medical History, Cabanis's Revolutions in Medi-
cine, Friend's History  of Medicine, and, latest and best, Kurt Sprengel's
great work on the same, in nine  volumes.   I name those which are before
me, and which will  reward study, and make pleasant relaxations  from
severer studies.
   The two  following years  will embrace the study in  all branches of
medicine.   Two full courses of lectures, with dissections, daily visits to  a
large hospital, and  diligent study of medicine in its  varied  literature.
These two years form a most important  time for the student.   He must
lay his back to the work.  Everything else is to be subordinate,  and  used
only as means to help him  in his proper toil.   It must be felt to be toil.
He must read a great deal.  He must forget a great deal to know much.
A volume may give him but a  single thought  or fact  for memory, but
that fact will  be a jewel.  It has cost time, but it will last forever.  Said
Johnson to a young  man who was vaunting himself on his wide reading
and knowledge, " I  have forgotten  more than you ever knew."   I once
consulted a very aged physician, of much reputation in our community,
on the treatment of an advanced case of fever.   He went to his book-
shelves, and from a high one took a  volume which was Brocklesby on
Fever.  He  turned  rapidly its leaves, and in  a  minute or two put his
finger on a particular paragraph, and bid me read it.   I did so.   It stated
that in some moments of advanced fever an emetic was useful.   Said my
friend, " I have not opened that book before for forty years."   Probably
that one paragraph, which contained what he judged to be very important
knowledge, was the only one which remained in his long memory.   The
student then must put it to his account  to  read  a great deal.   Let him
from the beginning of his  studies  keep a Common Place Book, and into
this let him  make  daily  entries  from books, and of  such  thoughts  as
specially occupy him  in  study.  A vast help  is this  in the  study of a
science so full of fact and theory  as ours.  I may add, I hardly recollect
a  distinguished man  in any field of literature  or  science, who has not
faithfully  availed himself of this  means of acquiring  and retaining  at
command,  knowledge.  Examinations  with fellow students are always
useful.  I remember  a  public medical teacher of much eminence, in re-
commending such exercises, said, that a  student could hardly be said to
know what he had not in words, in language, communicated to another.
   Three years and a  half are  now disposed of.   Let the student now
present himself for a degree.  I  think with this preparation, he may do so
with some confidence.   Having obtained  his degree, let him go to Europe
for a year, and study  medicine  in  the vast practical school  which  is
established there.  I would advise him to give four months of the time 
31
to a residence in a Lying-in Hospital, to which is attached wards for the
diseases of women and of children.  Dublin offers a most excellent field
for such studies.  Let the rest of the time be filled with such studies as are
most favorably  pursued abroad.  Branches which  were first  studied at
home, may be  practically reviewed there, especially  the collateral, while
for the immediate, most ample opportunities exist.   Permit  me  here to
offer a swu^fecaution, and which  has application  to the whole  time of
study.   I  think it  is  needed in  the present  day.   Let  the  student be
careful to avoid  exclusive  regard to particular diseases.   Within  a few
years special attention  has  been  directed to a  few particular subjects-
Laennec, Louis, and others, have  given an  interest, which may become
paramount, to particular diseases.   Fever  and phthisis are among  these.
Great interest has come to  be felt  in the diagnosis of  these affections, and
it has reached great perfection.  Their anatomical characters, as observed
after death, have been so  thoroughly studied, and their laws so  accurately
established, that perhaps  little more is  to be learned concerning them.
But they  form  but  a very small  part of pathology, and to  be too ex-
clusively  devoted  to  them  will interfere  with  the  acquisition of a vast
amount  of  indispensable  pathological knowledge.   A physician  should
never be a  devotee to specialties.   He must not be a  slave to the rare
or to the few, however important.   His pathway lies through  disturbed
functions, oftener, much oftener, than by the side, or through the regions,
of grave lesions.   He  must be very apt to detect the former,  and to re-
lieve them, too,  or he will not have a wide name, or a very full practice.
Medicine must not be to  him  a  " wonderful  magazine."   It  may be, it
will  be, a book  in which  he may read " strange matters ;" but he will
find in it everywhere problems  of the every-day, and the true, in which
thousands are more or less deeply interested, and of which they will look
to him for the practical solution.   An  exception to the  rule  suggested
here, may be found in some  strong  predilection for some particular branch
of the  profession.   Especially may such arise when  the medical student
is at work in Europe.  Suppose now he have strong  preference for some
particular investigations, or to prepare himself for some particular branch
of his profession, whether  in medicine or surgery.  Let him give time to
such.  He may  do this without important sacrifice of other matters, and
come home in his general preparation for professional duties, with a special
knowledge  which may stand  him  in excellent stead, and fit him for im-
portant special services to  others.
  And now let me ask what will be  the product to the student of so
much time, and of such faithful employment of it.   1 say experience.  By 
32
this word I mean here that intellectual perception, and that appropriation of
what others  have seen, thought, and recorded, as will make them his own,
just as if he  had witnessed them  himself.  His mind has  been  daily in
sympathy with  the  minds  of others.  He has not only  imbibed  their
spirit, but he has got their  knowledge.  They have  been to him eyes,
and he has through them had  perfect vision.   Barthez says somewhere,
"that a man of strong judgment, and competent sagacity, may contribute
much more to the real progress of a science of facts than he who is prin-
cipally occupied with experiments."   So our student  in the  wise  use of
his own mind upon what others present to it, may come to make a better
use of knowledge than  its teachers.   The course of preparatory  study,
however, above indicated, will bring the student into  direct contact with
facts, with disease in its present living example, and  so  make  him  its
witness.   It  will do this for  him, when his mind is  prepared for observa-
tion, and for  reflection  upon that which  is presented to it, and  so daily
enable him  to institute  comparisons between  that  which  he reads and
sees, that authoritative inquest which is to  result to him in truth, namely
in  all that truth to which he is at the time able to reach.
   I may be asked if my subject does not demand some allusion to those
moral  qualities, and  personal  habits, which take so  wide  a part in the
progress of a professional  man, and if  I have  no  detail of study to
present ?  I  say no.   Vogel, a  German  writer  who  has written  at
much  length  on  the education of the medical student, has devoted a
long chapter to  the first topic, and Young, in his Medical  Literature,
both  before  me, does the same for the latter.   Young  takes the  fu-
ture physician at 2  years of age, and  prescribes  specific  studies for him
till 18,  and  then teaches how  in the three succeeding years he may be
made into a  physician, a surgeon, or a what not.  But 1 have here no di-
rections to offer.  If I have succeeded in my attempt to show somewhat
concerning the true nature of  medicine, and in what  consists preparation
for it—if I  have said  that which will  make the  student faithful in his
studies, have spoken for them, so to sav, all  his  time—if I  have done
that which will bring into living action his intellectual and moral nature,
and showed  him what it is to  be a man in  his noble calling—if I have in
any true sense done these things in  the  short hour we have now passed
together,  I shall not fear but there will come out of it a true revelation of
what a man's conduct should  be to secure  for him all  needed success.   It
may not make him  a very rich man, but it will prevent his being a very
poor one.   It may  make him  a wise  and a good man, and with such re-
sult, is  it  not the truest success ? let him  be content. 
 
,  4