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METHOD OF STUDY IN MEDICINE,
GEO. T. STEVENS, M. D.
 
 
METHOD OF STUDY IN MEDICINE
                  THE

       INTRODUCTORY LECTURE

                 TO THE

            COURSE OF 1872,

                 AT THE


ALBANY MEDICAL  COLLEGE,


       DELIVERED SEPTEMBER 3, 1872,
    GEO. T. STEVENS, M. D.,

PROFESSOR OF OPHTHALMIC AND ORTHOPEDIC SURGERY.

»
\£ )>
PUBLISHED BY THE CLASS.   ^<l*t-/l 1_\S- •
      ALBANY:
VAN BENTHUYSEN PRINTING HOUSE.
         1872. 
OOKKESPOKDENCE.
                                      Albany, Sept. 5th, 1872.
Prof.  G. T. Stevens:
  Dear Sir—The students composing the present class of the " Albany
Medical College" unanimously desire your introductory lecture for pub-
lication.
  Hoping you will comply with their request, we remain
                           Very truly yours,
                                       G. H. BENJAMIN,
                                       AUSTIN A. SNELL,
                                       FRANK  M. BOYCE,
                                                   Committee.
                                     Albany, Sept. 10th, 1872.
To  Messrs. G. H. Benjamin, Austin A. Snell, Frank M. Boyce,
      Committee.
  Gentlemen —Thanking you and the members of the medical class for
the kind appreciation with which my Introductory Address was received,
I herewith enclose the manuscript.
                     Very respectfully yours,
                                      GEORGE  T. STEVENS. 
ADDRESS.
                         ------♦»


   My colleagues have assigned to me the duty of welcoming you
 to the course of study and  instruction in the science of medicine
 and surgery, to be inaugurated here to-day, and I assure you that
 nothing could give me  greater pleasure than  to welcome you to  a
 thorough and systematic course of study in your chosen profession.
   And now, as you  are  about to  commence what  we hope may
 prove a systematic and a successful course of study, we  can per-
 haps engage our  first  hour to no  better advantage than in  the
 inquiry, how we may best attain to the end in view—a practical and
 useful knowledge of medicine and surgery.
   I therefore ask  your attention to a few suggestions regarding

             THE  METHOD  OF  STUDY IN MEDICINE.
   It is to no light  and joyous task that you are welcomed or invited,
 when you  are introduced to the study of a profession which must
 rank as a learned  profession.   There  is no royal road to learning
 but  the old path of unremitting labor; and while  of late many
 wonderful  discoveries  have  thrown  great   light upon  hitherto
 obscure questions  in medicine, thus seeming to clear up the science
 and  relieve  some of  the labor required  to  attain it,  these very
 discoveries  have so enlarged  the field of scientific  inquiry  as  to
 increase rather than diminish the toil of acquiring the knowledge
 necessary to the intelligent  practice  of the profession.
  New branches  of study  are introduced,   New  standards  of
 preparation and culture are  demanded.
  A  few years ago, all the branches deemed  necessary to be
 taught in a medical college, or essential to be learned, in order to
qualify the student  for the duties of the practitioner, were em* 
4
bodied  in  the instructions of  a  very  few  teachers, who  were
supposed to be thoroughly  versed in all the lore of  the profession.
The United States Dispensatory, Cooper's Surgery, and Eberle's
Practice, constituted a respectable  scientific library  for the young
practitioner, and it too often  happened  that the only additions to
that of  many,  longer in practice, were only the bound volumes of
some single medical journal.
   Thirty, forty  years  ago, there were men  of  vast  learning, and
of great research in the medical profession; men whose names will
at all times be justly enrolled with the greatest of thinkers and of
scholars ;  but less was expected of the  ordinary practitioner than
is to-day demanded, and the training which  would then have been
regarded as adequate, would not now be  thought respectable.
   The great advances in medicine  and  in  general  science within
the last few years, have so extended the  boundaries of the medical
knowledge, absolutely  required by even  the beginner in  practice,
that greater division of labor has been  rendered necessary in the
instruction of  the  science.  Men whose researches have Leen great,
and whose  experience has been almost without limit in the general
field of medicine and surgery, have  found it impossible  for them
to follow  the  special  branches of the  profession to the  .extent
explored by individuals who have  pushed  their investigations in
special  directions.  Thus, one by  one,  innovations  have  been
forced into the curriculum  of medical instructions.
  The professor of practice  first called to his  aid the teacher of
obstetrics,  and he  in turn calls another to  instruct in the diseases
of women.   A broad field of  investigation is open in  the study of
diseases of the  mind,  which the general  practitioner can  hardly
hope completely to explore, and the t-pecial student of psychology
is called upon to tell us of the new and important advances made
in his province.
   Di the domain of surgery the range of inquiry has been equally
extended, and  he   who  now learns  hut the outlines of surgical
theory  and practice, is but poprJy prepared for the  duties of the
practitioner.
  There have rarely,  if ever, b,een  so  many  brilliant  advances
made in any science, in the same length of time,  as have been made
within the  last twenty  years in the knowledge  of  diseases of the
eye.  From being an   obscure subject, but  comparatively little
understood by even the most learned, it has, by  the  labors  and re-
searches of such men as Heltnhpltz aijd  Donders,  Von Graefe and 
5
Leibreich, been  advanced to  the  rank of a  new science, and  I
might  almost  say, that  a  new  profession, based  upon more
accurate  knowledge than  any other branch of medical science, has
been founded by the labors and discoveries of these great men and
their co-workers.
  I have alluded to a few of  the recent advances in science,  only to
remind you that  your field  of labor is greater than that of your
predecessors, and that greater acquirements are demanded of you
in proportion to the increase  of knowledge in matters pertaining to
your profession.
  But how is the  student  to meet this  increased  demand for
knowledge of his  profession ?
  In the first place,  the student should not enter upon his medical
studies until he has  attained to a good  knowledge of the elements
of science, and of subjects of general learning, nor until his mind
has received such a training as to enable him to compare and to
analyze  the facts  and theories presented in a course of  medical
instruction.
  It is too  often the case that medical students commence  their
professional studies with a shamefully inadequate preparatory edu-
cation ;  and yet such students  expect to enter a learned profession,
and they cannot but know that when once a  course of professional
studies is commenced, it is next  to  impossible to  go back  to pre-
paratory studies.   That a student of medicine should be possessed
of at least a fair  classical education, every intelligent person must
admit, but there is, at the present day, a demand for another kind
of preparatory education  on  the part of medical students—I refer
particularly to a knowledge of natural science.
  The methods of study  in  a  profession whose doctrines are, and
must be, based  upon  the unchanging laws of nature, should be
purely scientific.   At the  very outset, in  his  course, the  student
comes  in contact  with questions  of correlation of forces, of the
highest principles of mechanics, of the most delicate chemical reac-
tions, and of the most intricate and  beautiful physical phenomena.
The very first branch to which the student applies himself, should
be the study of the structure of the body and the functions of the
elements constituting that structure.  But how is he to understand
the philosophy of  cell life, or of  any of those physical  phenomena
which  actually constitute  life, who has not already mastered the
science of physics ? or who can, in any adequate degree, appreciate
the teachings of physiology,  who begins with the highest and most 
6
complex of all created bodies ?   As well might the novice  attempt
to cast the time of a coming eclipse, who is ignorant of the motions
of the bodies involved in the phenomenon, as for a student thoroughly
to comprehend  the doctrines of physiology, who does not begin by
attaining a knowledge of the structure and functions of the lowest
organisms.  I  cannot too  strongly impress  it upon the  mind of
every one, who would  enter  upon a  successful course of  medical
studies, that a  knowledge of natural  history is of the  highest im-
portance ; for not only are  the facts  of comparative anatomy, and
physiology of  plants and animals  of  simplest structure, essential,
but the habit of mind, the peculiar training of the intellect, which
is obtained only by this kind of study, is also essential.
   The habit of mind acquired by the study of natural history is
precisely that which is required for the  successful study of medi-
cine.   To use the words of a learned writer : " The habit of seeing;
the habit of knowing what we see; the habit of  discerning differ-
ences and  likenesses;  the habit  of  classifying  accordingly; the
habit of searching for hypotheses, which shall  connect and explain
facts ;  the habit of verifying these hypotheses by  applying them to
fresh facts; the habit of throwing them  away bravely if they will
not fit; the habit of  general patience, diligence, accuracy, rever-
ence for facts for their own sake, and  for truth for its own sake; in
one word, the  habit of  implicit  obedience to  the laws of nature,
whatever they may be,—these are  not merely intellectual, but also
moral habits, which will stand men in practical good stead in every
affair of life, and in every question, even the most awful that may
come before us as rational and social beings."
   And if these words are true for others, especially valuable are
such truths to a medical student,  the very essence of whose study
lies in the  careful comparison and analysis of the facts and  phe-
nomena of nature.
   I would be  glad if every student was  required to  pass a strict
examination in natural  science before he should be  admitted to a
medical course ; and I earnestly advise you, that if you possess  only
the meagre semblance of a scientific education ; if you  have little
or no  knowledge of natural history and of the great workings of
nature about you, then you had better defer  your medical studies
until you have  a more complete preparation ; for  in this age, when
" dust and disease," atoms and molecules, matter and  force,  light
and  electricity, magnetism and heat, are  subjects entering promi-
nently into  medical discussions, and  when sewage and water sup- 
7
ply, ventilation  and  illumination, fermentation  and putrefaction,
epidemics and  contagions are among the most  practical medical
questions, he who has little or no knowledge of the natural sciences
has but an indifferent preparation for  assuming the character of a
medical student.
  If the student has already learned  the habit of careful observa-
tion and sound  thought regarding the  things which surround him
in nature, he is  ready  to  assume his  medical  studies with intelli-
gence, and he has  the best preparation for the second  essential
element of a successful course of study,  viz., the formation of the
habit  of  original  and analytical  research,  and of  the careful
correlation and  comparison of the facts which he learns.
  A mind may be perfectly receptive  of facts, but not  receptive of
the ideas which should correlate those facts.   It is not uncommon
to meet  with gentlemen who are well informed, who can tell you
the facts which  are current in intelligent circles, or facts regarding
their  profession, who are utterly incapable of  understanding  those
facts, or of arranging them in any logical sequences.   Their minds
are  vigorous in one  direction,  and  almost  utterly  lethargic  in
another.  And what is the cause of this  weakness ?  Is it that the
mind  of such persons is  incapable of reasoning ? that  it is so con-
stituted as to receive  facts,  but incapacitated  for digesting  or
assimilating  those facts?  This is perhaps  the true explanation in
some instances, but in many, if not in most, I think that it is due
to the habit  of accepting facts  without attempting to  assimilate
them, until the  will grows weak, and  it at length becomes impossi-
ble for such an  individual to arouse himself from this  species of
mental inertia.   Such men accept and adopt theories in science or
religion which  have no possible  foundation in  either science  or
theology; and  they are usually  enthusiatic for the theory  which
they  have  accepted, and wonder  that any  one  could, by any
possibility, arrive at conclusions  different from  theirs.  Men who
thus  enthusiastically adopt wild theories  in  medicine, are often
called quacks, but they may be neither ignorant nor dishonest.  They
are often well informed, and among the most conscientious  in the
profession, but  from the habitual custom of accepting facts with-
out  forming  ideas, their minds  become at  length   distorted  in
certain directions, and utterly  closed to the true meaning of the
facts  received.   Every such man, conscious  that he knows  many
things, and believing that every phenomenon  is the  effect of  its 
8
 antecedent, is wiser in his own conceit, than seven men who can
 render a reason.
   Men who are  accustomed to digest and assimilate knowledge  as
 one  digests and assimilates food,  and  who form, with the  ideas
 thus  assimilated, new  combinations which are  as identical  with
 their mental as  their features are with their physical personality,
 are said to be original; while those who acquire knowledge, but do
 not create  ideas, are said to lack originality.   Now, what I desire
 most earnestly  to impress upbn  the mind of every  student  of
 medicine is, that he should by all  means become an original and
 independent thinker; and by originality I do not wish to be under-
 stood that  he is to despise the conclusions of the fathers, nor by
 independence, that  he is  to  disregard the views  of  others, for
 assumption is not originality, nor is  independence obstinacy.
   The condition of mind called  originality, may be cultivated even
 in those who by nature possess little of it.  It is not probable that
 the  majority of persons  who  have been  successful in  original
 investigations in physical  science,  have  been  men of exceptional
 mental powers naturally, but  in  these cases  mental growth has
 been the result and  reward of mental exertion.   As the  physical
 exercise of the cricket field, or  the boating  club, proves  to us that
 the  powers of the  body  may  be  wonderfully  developed  under
 discipline,  so  we may be assured that the intellectual  powers are
 to be improved by a like course of training.
   And as,  by badly  chosen or illy conducted physical exercise, one
 set of organs may be developed  at the expense  of all the others, so
 in intellectual training,  one set of faculties may be neglected while
 another is cultivated.  The result is, that the mind so trained fails
 in that masterly discernment which should enable  it to attack, suc-
 cessfully, difficult and obscure  questions.  As medical  students,
 you may conduct your education upon  the  plan of developing the
 powers of  sensation, or of developing  those  higher attributes of
 human intelligence—reflection, comparison and   volition.    The
 student who  carefully records in his note-book every prescription
 which he sees written on the blackboard, is conducting his educa-
tion on the first plan.   The  impressions  which he gains and  pre-
serves in his mind by the help of his note-book are of precisely the
same kind as are acquired by a learned pig, when under the instruc-
tion of his master.  The educated animal learns to connect certain
actions and sensations of his own with certain signals given by the
master, and in like manner when such a student hears the name of 
9
a certain disease, he as instinctively calls to mind certain combina-
tions of articles of the materia medica.  He has learned that cer-
tain signs in the sick man  indicate certain  diseases, and that for
each disease there are certain drugs or combinations of drugs to be
administered.   He goes into the world with  his brain-load  of im-
perfect knowledge and  faulty associations, ready to comprehend
everything that is easy of comprehension, but unable to cope with
knotty questions;  ready,  if circumstances favor, to  accept  and
adopt fancy theories in pathology and therapeutics, and with views
narrow, contracted, and often bigoted.
   Such a man can  apply  the prescriptions  copied from  the  black-
board, or derived from his books or journals, to diseases which he
is able to  remember  by name, but when an  obscure case occurs,
one  which he does not remember to have heard described, or which
does not assume the form agreeing with  the impressions made upon
his  memory, he is as much  lost in  his wilderness of diseases  and
prescriptions as ever were the  children of Israel in the wilderness
of Sin.  He has no guide but  memory, and  he  h;is so  loaded his
faculties with experiences and  impressions that he has  no  power
for generalization.
   On the other hand,  the student who  cultivates the  higher attri-
butes of  reflection and comparison is  ready for  any and all  emer-
gencies.   Like the other, he must have facts.  His  memory must
retain the materials from which he would evolve his  ideas, but he
has  learned to arrange these materials  with  precision, and  yet in
an infinite variety of forms.  The force and penetration of his mind
is increased as he extends his sphere of knowledge; and his ac-
quaintance with  a multitude of objects, instead of  burdening his
mind, as in case of the other, only strengthens and stimulates  the
reasoning powers.  Such an  one is  ready to deal with  new issues,
and  he delights in nothing so  much as  difficulties.   He searches
for the keys which unlock the mysteries which nature has so care-
fully hidden, and it  is to  such men that we  are indebted for  the
solution  of  the  great  problems in physics  and  philosophy,  which
have already added so much to the store of human knowledge  and
human happiness.
   It is the  duty and the  privilege  of every  student of  medicine
not only to use well the knowledge which he receives from others,
but to add to that already possessed by the world.  He should  not
only live up to his science, but he should advance it.
  Severe intellectual exertion, careful analysis of facts, enthusiasm 
10
in study, and never-failing persistence, are the price which must be
paid for success in scientific attainments.
   It may not be your good fortune to connect your name with any
great discovery, as is that of Newton with the  law of  gravitation,
or of Bunsen and Kirchhoff with the spectroscope, or of Helmholtz
with the  ophthalmoscope ;  but every young man who properly culti-
vates both the perceptive and conceptive faculties of the mind, who
is acute  and  active in the  observation of the facts, and logical in
his deductions from the facts within his own sphere, may and will
lift the veil which hides some of the choicest treasures of nature.
   There  lived not long ago, in London, a newsboy, the son of a
poor blacksmith.   The newsboy's capital consisted of good " natu-
ral powers, combined with zeal and capacity for hard labor."  The
newsboy  became a bookbinder's apprentice,  then a teacher.   He
became an ingenious experimenter and a lecturer.   With restlesg
and fertile  intellect, stretching out  in a thousand different direc-
tions, he was filled with enthusiasm, with curiosity and with won-
der.  The newsboy became a  great  discoverer, the correspondent
of emperors and kings, the  friend of Humboldt  and Herschel, of
Davy and Dumas, the recipient of honors from societies of learning,
and from princes and from  governments, and the  name of Michael
Faraday  will be for all time enrolled as a prophet and a priest of
science.  And if Michael Faraday, starting in poverty with his bun-
dle of newspapers, could attain to such a lofty eminence in science,
by his faculty for zeal and hard labor, will not such zeal and labor
do  for any student more than to make him a  mere imitator and
user of other men's ideas ?
   If the  student has formed the habit of original and independent
thought,  he  will  be likely to find  that the  teachings  of modern
science throw great doubt, if they do not wholly  overturn many of
the theories which have for centuries been regarded  as the main
pillars, upon which rested all lesser theories of Therapeutics and of
Pathology.   There have  been protesters  at all  times, and some
have been wise in  there protestations, while  others have protested
for the  sake  of  the  attention drawn upon themselves; but, for
whichever of these reasons  the protest  has been made, there  has
been, as  there always  will be, powerful opposition.  And  if you
should be so bold as to suggest that  some doctrine, long held in
reverence by the  profession,  is  but a  myth,  you must  expect
ridicule until  the truth you proclaim  is heard by the world, and
then comes abuse. 
11
  Nevertheless, be careful to examine all  doctrines, and bold to
throw them away if they will not stand the test of logical inves-
tigation.   You may meet  sneers or rebukes from those who have
for  many  years accepted  these  theories ; you may  be called
fanatical and fanciful, or you may be accused of a want of honesty
of purpose, for the time  is not long past since
            " The reverend grey-beards raved  and stormed,
              That beardless  laddies
            Should think they better were informed
              Than their auld daddies."
  And although we of the  present day claim to be more tolerant
of new views than were  the "auld light caddies;"  yet, as the vol-
leys of Dutch oaths,  let fly  by Govert Lockerman, in the days of
William the Testy, still linger among the  echoes of the  Dunder-
burgh, and are heard above the roar of the  thunder in that region,
so the echoes of railings and vehement  denunciations of the fathers
against new doctrines, still echo among the  discussions in science,
and the champions of  the good old views cannot even now forbear
to express themselves with a considerable degree of emphasis.
   I am not here to teach or  to encourage heterodoxy, but the days
of  superstition,  even in medicine, are  not clean gone.  There
stands to-day a flaming idol, to which the  doctors  of all kindreds
and nations and peoples have bowed.  The gleaming words. Rubor,
Color, Dolor,  Tumor,  flash from  its  glowing surface  and  send
terror to stout hearts.  And at the sound  of the given signal,  all
the doctors must fall down  and worship  this inflammatory image.
No man  can  describe  this  idol, inflammation, but certain  bold
young  thinkers  dare  to assert that he is  nothing but  lazy, and
therefore perverted nutrition.
   And then there is  the taint of blood in hereditary disease.   To
be  sure, no one ever saw the taint in the blood.  No one can tell
what or how it is, but from  time immemorial it has been known
to be in the  blood, though  how any one  ever knew it, no one can
ever tell.
   Here comes a child with  a  cleft in  the roof of  its mouth.   Its
mother ha 1 cleft palate and its great  grandmother.  Is the cleft
in his blood ?  You and I may think it is in his mouth !
   There  are more superstitions than  these, but happily they are
fast disappearing before the  positive light of science. 
12
            " Poor gapin', glowerin' superstition,
              Wae's me, she's in a bad condition;


            Alas, there's ground o' great suspicion
              She'll ne'er get better."
  Medicine,  to-day, is  becoming, to  a  great extent, a positive
science  founded upon the grand principles of physical laws.   The
time for men to look upon disease as an entity which is to be driven
out of the  system by something which will  produce a similar or
a dissimilar disease, has passed.  Pathological  conditions are but
the shadows of physiological actions.   Life, in the  words of  Fara-
day, "is but a chemical action  long continued," and disease  is but
a derangement of this physical  phenomenon.   We are, henceforth,
to seek for the deranged action, and  apply the same means for it?
correction as would be used for the  same purpose in the physical
laboratory.
  If science makes  greater demands upon its students  than for-
merly, it also furnishes him inestimably greater  advantages.   The
recent discoveries in physiology and  pathology have so elucidated
these phenomena, that they are no longer to be studied as a multi-
tude  of isolated and incongruous facts, but as  great  principles.
This  union aud  scientific  arrangement of facts has  relieved  and
promoted the study of these branches as much as the  natural sys-
tem of classification has aided the study of natural history.
  New  instruments, too,  have  been  devised, by which  studies in
physiology and  pathology are prosecuted  to  infinitely greater
advantage than formerly.
   The microscope,  though an  old instrument, has, of late  years,
been used so much more  extensively in  pathological and physio-
logical research  as to have become new in the hands of the profes-
sion,  and its revelations are  becoming  daily more startling  and
important.
   The ophthalmoscope, unknown a  few years ago, has assumed an
immense  importance as  an aid to  diagnosis and in the study of
pathology in the living subject, not  only in  diseases of the  eye,
but in disorders of the nervous system and of the great depurating
organs,  and the time has come when no  record  of intercranial or
nervous disease can be  considered perfect, which does not contain
a description of ophthalmoscopic appearances.
   There are other new aids to  diagnosis, like the largnyoscope, the 
1:}
endoscope and the sphygmograph, which, to use  the words of Mr.
Allbutt, "have a kind of alacrity in  sinking  out  of  notice," yet
they are of  much value and will prove of service to him who has
patience to use them.
   Persistence and  untiring zeal are essential elements of success
in the study of medicine.
   He who supposes that, having spent the time of  study specified?
and having  passed the examiration  required, in order to  obtain a
diploma conferring upon hinWne degree of doctor of  medicine, he
has, therefore, completed his  medical education,  is woefully mis-
taken.
   The  diploma granted  by any medical  college is, of necessity,
only a certificate that the holder of it has attained to the minimum
degree of proficiency in  his profession, which will enable him to
practice it with any  safety to  himself or  the  community.   He is
sufficiently  qualified to begin to study alone, and by assuming the
care of the sick is enabled  to pursue his  studies at the  bedside as
well as in his library.  The instructions already received from his
preceptors then begin to  assume practical form,  and he may, rely-
ing upon his  powers of observation,  apply the facts  and  theories
stored in his memory to the realities  of health and disease.
   The physician, so long as he continues to bear the name of phy-
sician, should be a progressive man.  He should  keep pace with
his times, not only in purely medical questions,  but in all subjects
of general intelligence, and especially in all subjects  pertaining to
 natural science.
   Such studies, so far from interfering with the si.udy of his pro-
fession,  will give him broader, more liberal and more definite con-
 ceptions of the facts of medicine, and if natural  science  can do
 much for you, you also can and ought to do much  for it.
   Of those who are before  me  to-day, some will go to the  country
for their practice, where  they will be brought face to face with
 nature.   I would  be glad if  every such  physician's office was an
 advance post of natural science.  Every such physician may, with-
 out in  the  least  hindering his practice  or  interfering with  his
 proper studies, make a  complete collection of all  the plants, min-
 erals, and  even animals, of his town or  county.  He may make
 meteorological observations which will be of service to hims:lf and
 to science; and, above all, he may, and should,  be the  minister of
 science  to the people among whom he practices.
   To those who settle in larger cities, these studies will be pre- 
14
sented in  a  modified form, yet in  reality they are  tne  same.  To
the physician of the city, the  great  questions of hygiene present
themselves as among the most  important subjects which can engage
the attention of the physician  or the philanthropist.  The science
of protecting the health of larger communities cannot be well under-
stood by one who  simply knows the rules of prescribing for  the
sick, and yet the highest duty and privilege of the  physician is as
guardian of  the public  health.
   Plagues and pestilences have swept through great cities, slaying
scores of thousands of  victims, and at such  times Death laughs at
the art of prescribing.   Much has been  done, but  more must be
done, to  arrest the dissemination  of epidemics, and to avert  the
dangers of  pestilence—and to whom  are we to look  for  these
results, but  to the  physician ?  '
   Only a month ago, came flashing under the  sea, the intelligence
that in Russian cities, hundreds were falling victims to cholera,
and  but yesterday came  again the  word, that  from the cities of
India, tens of thousands of terror-stricken people are now fleeing
from  their  homes to  escape the  destroyer.   And what do  we
know of this dread visitation ?
   Invariably,  from those great  cities  on the Ganges, and  other
rivers of  India, to  which religious  pilgrimages are made at  stated
periods, where filth and moisture, fetid exhalations  and  con-
taminated water combine with famine and exhaustion, fanaticism
and  debauchery,  to breed  malignant cholera,  the pestilence is
carried by the returning pilgrims, until  it reaches the bounds of
India, then  it sweeps  over Persia and the region of the Caspian
Sea, and  appears  in  Russia.   From  Russia it makes  its way
westward, and, crossing the ocean, commences its ravages in this
country.
   Already the angel of death has commenced his western journey ;
he has crossed the Caspian, and has  reached the Black  Sea and
the Mediteranean,  ready to cross to Western Europe and to  make
his way to our shores.   And is there no way  of turning him from
our doors ?  To your profession and to you, gentlemen,  it is  given
to turn him back  and to save the people—and if  the  threatened
advent causes  less  terror  than  formerly,  it is  because of  the
increased confidence in the ability of your profession to arrest  the
evil.  It  is  yours  to sprinkle  the door posts  and the lintels, that
when this angel of destruction shall see it, he shall pass over  the
doors and shall not enter to smite the people. 
15
  I have called your attention to a few suggestions  regarding the
methods of study in your profession;  but  possibly some  one says
to himself, this may  all  be very well in theory, but  there  is
doctor so and so, who has a most  extensive and lucrative practice
among the wealthy and fashionable of his town, and yet he knows
as little of science  as the most illiterate boor; and you may bring
to mind physicians who, by persistent self-assertion, by extravagant
and boastful  pretences of cures, by display of equipage, or by the
constant claim  of superiority for the peculiar system or pathy
which they practice, have acquired  large fortunes without the aid
of scientific knowledge or  systematic discipline of  the  mind—and
you  may  possibly  say, of what use is all this method of study,
when one may get wealth as  well,  and even better without it?
   Gentlemen, if there is one here  to-day, who has entered upon
the  study of medicine only  as a means of acquiring wealth,  as a
trade, which he hopes may bring him  in more money than another
trade, my words have not been spoken for him.  If you would  be
rich, you may be a knave, a  mountebank, or a fool.   If you would
be honored, be a man.
   Let us believe, that every one  who here to-day enters upon his
medical studies, does so with  the  honest determination to be a
true  disciple of nature,  and to  devote  his best energies to  the
happiness and  welfare of mankind—assured  that  he is best fitted
to be a physician, who is most worthy to be called a man.