ADDRESS DELIVERED TO THE GRADUATING CLASS OF THE HUM MIL AT THE PUBLIC COMMENCEMENT, FEB. 18, 1847 1 BY M. L. KNAPP, M. D. PFOFESSOB OF M*TEBIA MEDICA IN TITE INDIANA MEDICAL COLLEGE ; PBOF. OF CHEMISTBT IN' THE UKIVEKSITT OF ST. MA BY OF THE LAKE, CHICAGO J MEMBEB OF THE NOETH-WESTEKN ACiDEMY OF THE NATURAL AND MEDICAL SCIENCES, ETC. CHICAGO : FRINTED AT 123 CORNER OF LAKE A.&D CLARK STREETS. 184T. 4991 * M. „ ._ • Indiana Medical College, Feb. 19, 1147. Pnor. Knapp, & Dear Sir.—At a meeting of the Students of Indiana Medical College, held this morning in the College building, G. D. Wilber in the Chair, and E. A. Hill Secretary, it was unanimously Resolved, That a committee of eight be appointed to solicit, for publication, a copy of your ■very eloquent, able and appropriate Address delivered last evening. Permit us to add, Sir, that by complying with the wishes of the class, you will not only reflect great honor upon yourself, but also on the Institution with which you are connected. With great regard, we are Yours, &c. TOMPKINS HIGDAY, New York, JAMES PRENTICE, Wishonsan, JAMES W. MANDIGO, Michigan, EUDORTJS EVERTS, Indiana, RICHARD R. STEERE, Rhode Island, D. C. ROUNDY, Illinois, A. F. ANDERSON, Iowa, S. M. CRANDALL, Mississippi, E. A. HILL, Secretary. "I ^.Committee. J G. D. WILBER, Chairman. Laporte, Feb. 19, 1847. Gentlemen : Your note of this morning, conveying to me the wishes of the Class that a copy of my address be furnished for publication, is received, and I take pleasure in saying, in re- ply, that the request is complied with, and herewith I send you the manuscript. It was intended as a parting lecture to the Graduates, to whom it was especially addressed, and I must, therefore, esteem the call for its publication by the Class at large, as evidence of its favorable reception by the Institution. If its publication shall, in the least, further the in- terests of this School of Medicine, as you intimate, and gratify the Class, I shall be satis- fied to have it go forth, though conscious of its imperfections. Please to present to the Class, and accept, Gentlemen of the committee, for yourselves, assurances of my high esteem and cordial friendship. Ever truly yours, &c. M. L. KNAPP. Messrs. G. D. Wilbeh, E. A. Hill, and Committee. Note.—A committee of three, to wit: Jno. W. Green, Theophtlus Fhavel and T. Hiodat, was appointed to publish the address, who waited on Prof. Knapp and requested him to superintend its publication, placing in his hands the supposed requisite amount of funds. ADDRESS. / Gentlemen: This is an important epoch in the history of your lives. You may look upon the occurrences of this day, as the closing page of your pu- pilage, and the opening of a new volume. You have reached the goal so eagerly sought; the agitating ordeal is past; the chief honors of our school are conferred upon you; and you now take your places, legitimately and quietly, within the precincts of the Medical Profes- sion. You are now Doctors of Medicine. Your assiduity, profi- ciency and virtue, have secured for you a titled profession, more en- viable than an hereditary Baronetcy; and one that will serve you, if rightly pursued, for honor and for profit, for business and for pleasure, during life. I congratulate you, young Gentlemen. The position you have now attained, is as creditable to yourselves as it is gratifying to your friends, and prospectively salutary to the interests of humanity. I con- sider you, this day, better off than he who can say, my fortune is made —I have money enough—the future may take care of itself.'—And I would fain say something to you before we part befitting the occasion. It has been my happiness to stand in the relation of teacher to some of you, for three successive sessions of this college. I have watched with peculiar pleasure and pride your expanding intellects, and the ra- pidity with which you have grasped the great outlines and dogmas of the profession. Your gentlemanly bearing at all times has won my high esteem. I feel the deepest solicitude for your future welfare : And casting a look back upon twenty years of professional experience; and knowing the rough ways of the world, and the up-hill struggles of life; I trust, neither you, nor this large and respectable audience, will con- sider ill-timed or out of place, some general precepts of advice. 6 The first question before you for decision is, where shall you settle? It is an important one. It involves so many considerations, and cov- ers such a field of results, that the motive finally determining the choice will be the cynosure of your destiny. An error in the commencement of a mathematical calculation vitiates the whole process; so may an error in the outset vitiate your career. As a governing principle in choosing a location, I advise you to seek a rich and populous district; or if your inclinations lead you to be among the first on the ground in some newly opened region of the west, let there be peculiar advantages, as navigation, water-power, mineral wealth, &c. promising the most certain and rapid advancement. Avoid more than you would the pestilence, a poor, sparsely settled, incapable region, where listless in- activity might supercede energy ; where intellect might slumber; and where in the idle and tedious probation of waiting for business, foul weeds might spring up in the mind and choke your professional aspira- tions. Your success will mainly depend on the numbers that dwell around you, and on their ability to pay for your services. All other considerations are of secondary importance compared with these.— There may be a choice, to be sure, in places possessed of these requisites, arising from personal adaptedness. One Physician may be better adapted to city life and practice, possessing a more disciplined ability in the art of prescribing, and -leaving prescriptions to be compounded by the Apothecary; whilst another may prefer a country life and prac- tice, and can compound and dispense extemporaneously, with acquired facility and tact, and with a satisfaction or security he might not feel entrusting these matters to another. Taste, habits, education, &c. grounding a preference in good and sufficient reasons, will guide you here. It is important that there be no fault in the place in the abstract; for should you find after a few years trial, that your location was an un- favourable one, much of your time and efforts, thus far, would have been spent in vain. It is a serious evil to be obliged to break up and begin anew. The advantages of a good location will be especially felt and prized by you in the further prosecution of your scientific and philosophic in- quiries. To be out of the reach of, and out of the way of obtaining, a particular author or piece of apparatus, when inclination might prompt to investigation, would be a great impediment. The favourable mo- ment when moved to engage in researches wTould pass unimproved, and the first step, perhaps, of a series that would have led to some 7 high achievement, would not be taken. The influence of congenial minds and the interchange of thought and feeling, so edifying, inspi- ring, and improving, would be lost to you in a bye situation. You might peradventure, find yourselves in the painful predicament that Professor B. the mathematician found himself, when he had finally solv- ed a problem that for years had puzzled the mathematical world.— There were no minds around him who could comprehend the solution, or appreciate his transports! The greater advantages of the Eastern cities have induced a more crowded state of the profession there. I would not advise you to resort thither, unless very peculiar circumstances invite you. Besides, vivid impressions of the diseases most prevalent there, continued and typhus fevers, syphilis, thisis pulmonalis, &c. may not have been so constant- ly transfered from your teachers' minds to you, as have the likenesses of the more prevalent Western diseases—malarious fevers and their com- y plications. Some of you have left the East to take your last course of lectures and graduate here, because you had resolved to seek a home and less thronged field for practice in the West, and believing there were some special advantages to be derived in studying its prevailing diseases on the spot. In this, I think you have acted wisely, notwith- standing the sentiments urged to the contrary by an Eastern school of great celebrity, my Alman Mater ideed, Jefferson Medical College, Philadelphia, in its last annual announcement. "The facilities which "Philadelphia affords for medical instruction," says this school, "are "certainly varied and ample, and adapted for every region. The great "principles of pathology and therapeutics can never be sectional; "they are of universal application; and there can be little weight there- ' "fore in the assertion—that, to treat diseases understanding^, it is "requsite for the student to be educated in the localities where they "prevail." Now with all due deference to the high authority from whence these views emanate, it is my opinion, nevertheless, that you have acted wisely in coming from the East to close your term of study and to graduate here, having resolved to establish yourselves in practice in the West; for I am convinced that the facilities which Philadelphia affords for medical instruction, though certainly varied and ample, are not entirely adapted to this region. They are too distant and expen- sive to be generally embraced by the Students who reside in these parts; and furthermore, they fail to impart to Eastern Students that 8 pathological and therapeutical knowledge of Western endemic diseases, which ensures the same success in practice as attends the graduates of this school. The idea sought to be conveyed by the specious ar- guments of Jefferson College is, that, there can be nothing sectional in pathology and therapeutics giving a local value to medical instruc- tion, and the better adaptation of knowledge thus gained to the cure of the diseases of particular localities. As if pathology and therapeutics were among the exact sciences, and like anatomy could be taught per- fectly, and for universal or particular application, in the treatment of the diseases of all regions, at one point, Philadelphia, for instance, and as well there as in the several localities where certain diseases more abound. Now all the world knows, that, the theories and doctrines in pathology and therapeutics are changing, improving, advancing, un- der the light of investigation. This is the morning star of physic, that lures its votaries on to discoveries and improvements in the healing art—the star in the east, that guides the seekers after truth, and illumes the path-ways of the science of medicine. The pathology of some of the most important diseases is very differently considered, understood and taught, in the different colleges; also the therapeutic indications to be fulfilled by, and the effects of remedies. I would be very sorry to entertain now, the pathological notions of malarious fevers (hat were taught me in Jefferson College, much as I venerate my Alma Mater ; and it would be a source of just and lasting regret with me, to have taught you as I was taught, or as the books teach, the therapeutic pre- cepts to govern the practitioner in the treatment. I can say the same of other forms of disease. Every school of medicine and every teacher, nearly, is the exponent of local or sectional doctrines. The peculiar doctrines of Cullen, Brown, Rassori, Broussais, Hahnemann & others, that have an astonishing influence over the minds of practitioners, but corroborate this truth. How obviously then pathology and thera- peutics can be, and are, more or less sectional, in the present state of our knowledge. It seems to me to be the common sense view of this matter, that gout will receive more consideration in London, yellow fever in New Orleans, cholera in India, &c. &c. Again, it is common sense and the common acceptation, the world over, that, pathology and therapeutics are best pursued, truth most certainly discovered, and instruction best communicated, where the means of observation for professors most abound. To gainsay this, would be denying the value of clinical observation in hospitals, and ex- 9 perience in the treatment of endemic and epidemic diseases. Is it of no importance, then, in the treatment of the endemic diseases of par- ticular regions that students be educated in the localities where they prevail ? It unquestionably is of great importance. Will they not, other things being equal, be better taught how to treat them understand- ing^ ? They certainly will. Can the genius of the West, its topo- graphical influences over the causes of disease, its medical physiogno- my, the constitution of its diseases, and the habits and constitutions of its people, be taught you, over the bodies of the squalid, scrofulous, syphilitic, inebriate subjects of the Philadelphia or other eastern city- alms-houses ? Not well, it appears to me. But Gentlemen, under the lights of observation and experience afforded your teachers in Western practice, m the treatment of our endemic diseases, you will go forth from this school of medicine, with a pathology and therapia that will avail you in the West like a magic wand, or as the brazen serpent did Moses in the Israelitish camp. Western people have already seen the Eastern bred physicians succumb to the superior skill of the graduates of this college, and the opinion that students must graduate at Laporte in order to practice successfully in the Northwest, is becoming preva- lent here. And humanity exhorts us to foster and promulge it; and policy will yet bring many students annually from the East, to gradu- ate in the Indiana Medical College, and to disperse, like you, through the west, to become the conservators of the life and health of the tide of immigration that is rolling in upon us. Your location being determined on, in some flourishing or promising town in the West, take up your residence there in mid-summer, and not before. The reasons for this are, you will then go directly into practice, at the commencement, technically, of the 'sickly season,' and avoid an idle interim in your affairs; the first impressions of the people will be favorable to your professional abilities; and it will give you ample opportunity, previously, to cast about, and canvass the comparative advantages of different points, and make every prepara- tion for beginning, and obtain every necessary article for the office, and author for the library—matters and details of great convenience and importance, and helping still further to make a good first impres- sion. But be wary of overdoing pretensions. Having the substance of physicians you stand in no need of assuming the show of pretenders, and thereby endeavoring to create a sensation, "To go up like the 10 rocket and come down like the stick," would be a calamity. I would have you aim at the meridian sun, but imitate the hawk, or the eagle, in the manner of ascent. Time, age and experience, are required to develop the powers of the master. The world is loth to accord to the precocious youngster, the ripe wisdom that years are wont to bring; and is ever ready to apply the homely adage, "soon ripe, soon rotten." The meteors of the prolession seldom or never remain its greatest mmi- naries. To draw a type from natural and familiar objects, I would say, study to begin your career like the unpretending rivulets you see rise in this Laporte region, and which, after a lengthy and swelling course, end, some in the mighty St. Lawrence, some in the great Mississippi. Deport yourselves like gentlemen, every where, and on all occasions, and when you appear in society let it be only in the best, for here is the rank of the physician in all parts of the world. Court society but little, just enough to let it appear you are perfectly at your ease there, and athome in the dance, or other amusements, but that your hearts are not there, save for the time being.—That you think more of your profession than of amusements, more of your patients than of the ladies. Nevertheless, so important is this ability to appear the guard- ed and well bred gentleman, in whatever circle or emergency thrown, that, the answer given a father, by a distinguished London physician, to the question, what were the requsite primary qualifications for his son, about to commence medicine, is in point. "Send him," said he, "to a dancing school, and to a fencing school." Cultivate no intimacies till you are thoroughly established and gen- erally known, and know every body. Society in the West is made up of people from every city, country and nation, who, for various reasons have emigrated, and clans and cliques are common, founded in the circumstances of nationality, provincial character, religion, birth, politics, wealth, &c. Now it should be your purpose, as your high aim is usefulness to the many, to steer clear of the trammels of particu- lar alliances, and to take an independent and lofty stand on the prin- ciples and practice of virtue, as American citizens. Standing on this proud eminence, and on your reserved rights, you will exercise the proper and desirable influence of Americanizing character, and oblit- erating the shades of difference in those around you, without imbibing the narrow prejudices of any. Secret societies and orders, or associa- tions founded on country, birth or descent, better he avoided. Their -embrace will bring upon you the odium of exclusiveness ; or you will 11 be counted agitators; or you will be found at the social board pan- dering to inborn prejudices, that are deep rooted and hateful, and that had better be forgotten. To become infatuated leaders, writers, or lecturers, on any of those questions that agitate and divide commu- nity, would not only be foreign to your profession, and distracting to your minds, but would, inevitably and irretrievably lower your stand- ing and limit and abridge the field of your usefulness. Beware of paying undue deference to persons of wealth. The sycophant, next to the hypocrite, is the meanest of all characters. The fool may be born rich—the mean man and the knave often become so. No man is better or happier for riches ; generally the reverse. Envy him not, court him not. As riches come in, the kindlier feelings are aptto de- part, &to leave the man of wealth a cold, selfish, purse-proud lordling. Ape not the airs & manners of such an aristocracy. They will burden you, if put on, as the armour of Saul did David. It is better to go forth to the fight with a shepherd's sling, that you can wield dex- trously, than with a broad sword, that may trip you down. Avoid the odious other extreme too—the Leatherstocking rusticity of pioneer life. Hunting-shirt custume, half horse and half alligator manners, slang speeches and Indian yells, are only popular with the twilight of civilization—that class that is always on the wing, going 'further back.' Its numbers, like those of the aristocracy of wealth, are few; the pat- ronage of either class is unworthy of your solicitude ; an alliance with either would prove a curse rather than a blessing. Extremes approach each other. Recollectthe observation of Jefferson, that "the middling classes in society are the most virtuous and happy." These it must be your aim to secure. You will soon find your happiness, usefulness and respectability, so connected together, and all so dependent on your professional suc- cess, that the most comprehensive scope of your minds will be required to enable you to plan with reference to professional advancement, and steer clear of clogs and impediments. This will frequently call for the exercise of great self restraint and present sacrifice, moved, as you will be, by the influences of society, manners, individuals, and perad- venture, snares purposely set. The perfectly schooled control of self that characterizes the philosopher, the government of the passions, the high stand taken to be true to yourselves, true to morality, and more than just, even kind to all, friends or foes, will bear you through 12 labyrinths of difficulties, and make the trials of life but the steps of as- cent to an ennobling greatness. It is, certainly, difficult for a young man, ambitious of public favor and preferment, and a stranger in a place, so to deport himself as not to incur the censure of austerity and reserve, and yet escape being in- sidiously led into the embraces of this or that faction, clique, or sec- sectarian influence in society. Many a young physician has not avoid- ed this alternative, and has afterwards repented his easy virtue, in this respect, when too late. Let no earthly considerations induce you to join any church, or religious society, for worldly advancement; and especially avoid this most inauspicious moment of laying your- selves liable, even, to the imputation. Religion is too sacred to be approached for worldly ends. Better were it for you that a millstone were tied to your necks, and cast with you into the sea, than that you should incur the difficulties and penalties of hypocrites in religion for life. But whilst I would dissuade you from an ill timed, and a Judas' embrace of religion, I would as earnestly enjoin upon you, in truth and soberness, to let every act of your lives be in perfect comformity to the principles of that comprehensive charity, virtue, and benevolence, in- culcated in the divine precepts of Christianity. No other principles of action will answer at the bed side. The consciencious rule of doing for the sick as you would be done by, is the one you must adopt in practice, and never depart from. This comprehends muchbesides the mere formalas of your art. You will be,called to treat the infirmities and diseases of people of, perhaps, every nation, and of every chris- tian faith; and to witness frail mortality when bereft of every earthly hope, and flying for succor to the only consolations left—the rites of their re- ligion, and "the peace of God thatpasseth all understanding." It will, be especially becoming in yon, and your duty, under such circum- stances, to inquire after their religious faith, and to aid in securing for them, the presence of those holy men of God, their priests, ministers & religious guides, whose sacred functions are never more touching, than when administering the last holy offices of the church, to perishing, pen- itent mortals. It will best comport with the comprehensive charity that should characterize the physician, that, he regard, alike sacred, the faith and ceremonies of all denominations, and with equal earnest- ness insist on the administration of the last sacred rites and observan- ces of all, that the shrived soul of humanity, may ever be wafted, on 13 the sweet incense of prayer, into the presence of its Redeemer and its God. If the decencies and proprieties oflife, should be scrupulous- ly regarded, how much more should the last solemn scenes of suffering and death, move the sympathies of those, whose greatest stretch of skill cannot prevail in the hour when the immutable decree must be executed—"Dust thou art, and unto dust thou shalt return." The truly great physician is never disregardful of the feelings that may agitate and distract the souls of his patients. And, in moments like these, who could endure the presence of a rough, unfeeling, scof- fing, or besotted medical adviser ? In times of deep distress and an- guish, when flesh and heart fail, we need the voice of kindness and of love. In scenes of peril, when the awful realization of the king of ter- rors bursts suddenly upon the imagination, to the almost dethronement of reason, we want, in the man of skill, one, whose benignity soothes and calms ; whose approach quells our fears, and whose presence in- spires hope ; seeming to speak in the midst of the storm, like the Cap- tain of our Salvation—"Peace, be still." When our Saviour was on earth, an embodied example to all men, and to all professions, multitudes pressed around him for the cure of their diseases. None were repulsed—none were neglected. The blind were made to see—the deaf to hear—the lame to walk—the fun- rious maniac, bereft of reason and his outward vestments, was restored to his friends, "clothed and in his right mind." The sick and distres- sed of every condition, were the objects of his universal benevolence, and of his Immanuel skill. The widowed, the fatherless, and the poor, were the special objects of his compassionate regard. The poor in Spirit_the destitute, virtuous broken-hearted—were cheered with the consolations of hope and a bright immortality. The fallen vicious were not condemned, scorned, frowned aside, but pitied, admonished, re- claimed. My young friends, go ye and do likewise. Imitate the spirit of the great physician. Let the basis of your philanthropy be as broad as the human family, and co-extensive with human suffering. Never tire in carrying the almost miraculous power of healing that sci- ence gives you, to the poor, as well as to the rich; and stop not when the requisitions upon your skill may be fulfilled, but faithfully perform all your moral obligations. Pass not by on the other side, like the proud Levite, but, with Samaritan kindness, pour the healing oil and wine into the sores and defections of the destitute and abandoned, and c 14 pointing the healed to the paths of virtue and peace, finish your good work with the mild and reclaiming admonition, "go, and sin no more." Do good from principle, and without cant. A good action brings a higher reward than the approbation of the world, or a return in dollars and cents. Motives are apt to be suspected if the action be boasted of. Let the healed chant paeans of gratitude. These shall be to you unequivocal praises. Be seemingly careless of these, and rather im- pute your success to close attention to your business, than superior skill. Nevertheless, lay up these things in your hearts ; they will avail you as incentives to the further daily performance of your delightful duties. They will give you great self confidence. See to it that they do not uplift you. Watch yourselves narrowly, but seem not to think of yourselves at all, through devotion to the best interests of your pa- tients. You have now become the objects of public attention. A more scrupulous regard, if possible, to the duties of your profession, in your relations to the sick and to society, is required. Fortunately for you, by this time, business has become a pleasure, and politeness a habit. Your uniform urbanity and skill render it apparent, that you practice no arts but the art of pleasing and the art of healing.—That, conscious of the rectitude of your motives and intentions, you bear about with you a high and an abiding self respect, that carries you above the subterfuges and tricks of the profession.—That, you leave to small minds the arts of dissimulation, cunning and manoeuvering, to get on in the world ; and, that you are too much occupied to find the time, even if you had the taste or inclination, to indulge in the vices that are some- what popular, and esteemed manly, by the equivocal better class of gentlemen. Whilst pursuing, with unremitting devotion, your duties as a prac- titioner, you must not forget the scientific cultivation of your profession. Medicine is a rapidly progressive science, and your whole duty to the sick cannot be performed if you fall behind the times, and do not keep pace with the improvements in your art. Besides the study of diseases and their treatment at the bed side, you should consult your authors on every important case. You should take several of the best journals, and their perusal should be made to fill up the crevices of your time. You will gather much information of a practical nature from them, and keep the run of new publications. I advise you always to have a work on hand—a new one—that you are reading in course. By a system 15 like this, you will preserve the habits and relish of students ; nay, you will do more, you will stir up within yourselves an exalted ambition for the attainment of the first rank of excellence in the profession. The modern languages should claim your attention. There is much medical literature in the French and German, and in many towns in the West, a knowledge of these is quite neceessry at the bed side; whilst the present attitude of our National affairs in relation to Mexico, and acquisition of provinces where the Spanish is spoken, render a knowl- edge of this language of some importance, certainly, as a contingency. The natural sciences, too, should be further practically pursued.— They can be cultivated, without interfering with other objects, to the ex- tent of affording the most rational delights, even in your business rides. Recollect that, "method is the soul of science." Methodize your op- portunities, therefore, of bringing the objects of nature under review, by the helps and treatises your libraries should afford, and, soon, you will have erected beautiful superstructures of knowledge, on the foundations you have already laid. It is a good plan to choose one branch of your profession, according to taste, and to cultivate it more assiduously, and attain extraordinary skill in this department, letting no opportunity pass unimproved for se- curing specimens illustrative of it. So, also, in the natural sciences. Take some high example for your model, in this respect, John Hunter, in comparative anatomy, for instance. His leisure hours and his spare money were devoted to it, all the rare animals obtained for the prose- cution of his researches, and when he was not in funds, which some- times happened, for his means were short at best, he would borrow. "Pray George," said he, one day, to a friend, have you any money in your pocket? His friend replied in the affirmative. "Have you five guineas ? because, if you have and will lend it me, you shall go halves." "Halves in what," inquired his friend. "Why halves in a magnifi- cent tiger, that is now dying in Castle Street." The money was lent and the tiger purchased. Begin this good work at once. The private collections of a life- time, have, in some instances, been truly astonishing, and have sold for thousands of pounds. Economize time—never be idle—suffer no one to lounge in your office—go and see a patient to get rid of a bore —or, if this will not do, go to sleep over him. It is a most useful practice, and one sanctioned by the highest au- 16 thority, to keep a journal of cases. It begets a habit of close observa- tion, quickens the skill in prescribing, and leads to a ready style in re- porting whatever may be useful for publication. It is well to have one or more Students, and to keep your elements fresh by drilling. A Student can frequently render you such service as will enable you to save your precious time. One thing is above rubies. It is, the ever steady, persevering devo- tion to the one object—your professional advancement. Whatsoever converges to this end, should be embraced as a means of promoting your usefulness; every thing irrelavent, that tends to engross the mind and retard your professional progress should be discarded. Beware, then, of the love of sordid gain. It debases the feelings, and begets an obliquity of thought and desire, and a distraction of mind, unworthy of him whose high function it is to save life. Make uniform charges to all your patients, according to the usage, standard or fee-bill; settle accounts often, and discount liberally to the poor. There is a large class of people dependant on daily labor for daily supplies; when health fails, the resources of this class are dried at their fountains. Your ut- most skill in prescribing, and greatest generosity in collecting should be exercised here. The chief gain you will derive from the poor, is their good will, aiding your onward career. Be prompt to creditors, especially your druggists, and they will be sure to answer orders, and take any pains to serve you. There is but one better mode of dealing that I can cite you to, and this, John Randolph of Roanoak declared the philosopher's stone. It is, "pay as you go." If you thus acquire more means than enough to support you, put your money at interest on bond and mortgage, where your administrators might easily find it and your families profit by it, but never employ it in other business and speculations. You had better give it to the poor, or—build a medi- cal college. The necessary business affairs of life must be so managed, in a word, as to consume but little of your time, and not harrasss your minds. I would be doing injustice to you, and violence to my own feelings and the position I hold, to omit in this place, inviting you to return soon and spend another winter with us, as a further means of cultiva- ting your profession advantageously and keeping alive a laudable am- bition. Our halls wall be ever open to you. We shall hail your re- turn with pride and pleasure. We shall greet you as among our fiFst- 17 bofn sons with whom our honor dwells. A winter spent in reviewing your studies, in dissecting and making 'preparations', either at this, or some Eastern school, should by no means be lost sight of by you.— Let me conjure you not to forego so great a means of invigorating your knowledge as visiting Philadelphia or New York would prove. Phil- adelphia is the great focus of Medical learning. Its schools, its hos- pitals, its museums and its libraries, should be made subservient to ' your interests and advancement, at as early a day as you can make arrangements to spend a winter there ; and I would be the last person in the world to dissuade you from visiting Europe for the same objects. Your bearing and conduct towards your medical brethren may be summed up in a few words. You must expect competition of course, it is unavoidable, and you will have competitors of every kind, from the high and honorable practitioner, to the low intriguing quack. I would have you neither seek competition nor avoid it. You have the inalienable right to establish yourselves any where, no matter if old de- ^ ified Esculapius himself be there. If you are adapted to the people, and the place is growing rapidly—requisites I have insisted on—and you pursue the course I have marked out, you will certainly go into practice. You will possibly have as much professional business as vou can do the first Summer. One of the first graduates of this school, after its reorganization in 1843, obtained practice to the amount of nearly three thousand dollars the first Summer and Autumn, settling himself in a country village, in Illinois, where there were four doctors. This is worthy of being mentioned along side of the far famed suc- cess of the celebrated Dr. Lettsom, who amassed nearly eight thousand dollars, in the first five months of his practice, on his return from Eng- z land to Tortula. The same high minded honorable course must be pursued to the Profession as to others. Be not frugally just, and meanly polite, but generous, and even magnanimous. Nothing will be so likely to win the good opinions of your brethren around you as to manifest your re- spect, friendship and good will for them. Be, to them, what you de- sire they should be, to you—open, frank and friendly. By respectful, manly attentions, ingratiate yourselves with the older members of the profession; by a patronizing, encouraging demeanor, attach the younger, and behave toward all, as though you believed there could not be a mean man in the ranks of so noble a profession. In fine, behave in such D 18 a generous and noble manner towards physicians that the world shall say, the fault is not yours if you are not on terms of friendship and in- timacy with them. The quack must be let alone. Treat him as a part of creation__ civilly—he will be satisfied with that, will not expect more, but nev- er disturb him. He has his friends, and you may gain them by aright course. You will let yourselves down to his level if you abuse him or quarrel with him, and yfhi will make his friends your enemies. This class generally makes as much business as it intercepts, that, finally, falls into the hands of the scientific practitioners. The people, everywhere, assume the right to judge of modes of curing, and of the qualifications of practitioners. Public opinion is law. You may en- lighten this by essays, lectures, expositions of medical doctrines, classes in physiology, chemistry, botany, &c. and by these means aid in the suppression of quackery, without attacking directly the prejudices of any. Here is a great field for usefulness and improvement open.__ Whilst laying your plans for life, lay hold of the spirit of the age. I would call, in a friendly way, on all the regular practitioners in the place, on opening office. You must not expect them to call on you first, and it will be useful for you to know them. You may need the support of an older practitioner in consultation, and you must expect that some of your patients, or their busy friends, will grow impatient, and want counsel. Never refuse. In consultation be just, firm, kind and true. The patient's good is the paramount consideration. Re- ceive the consulting physician's views, and carry out the treatment agreed on, implicitly. If you cannot agree, call a third. The voice of the majority isto govern, and the attending physician, in all cases, is to carry out the treatment. Suppress all feeling and passion. Act high and honorably. Meek in manners and bold in science will make you great in consultation. If called as counsel, never speak disparagingly of the attending phy- sician, or condemn the treatment, though you may think it to have been wrong. This would be cruel to the patient, and unjust to the physician. Save the patient's feelings by saying, it is impossible to judge; and you will gain the physician, by passing lightly over what has been done, to what must now be done to meet the indications.— He will have learned these, perhaps, by your more masterly examina- tion of the case, leading to clear views in diagnosis. Never call a se- 19 cond time unless summoned, or to meet at a time agreed on. The meanest of all things you can be guilty of, is to seek to undermine and supplant a professional brother, by vile insinuations and sneaking visits. It marks, if possible, a lower grade of professional prostitution, than falsehood, detraction and malicious combination. Let neither ambition, envy, revenge, nor any motive or passion under heaven, ever tempt you for once into any of these bye-ways of deep & damning corruption. He who wallows and wades in them hath need of staff for his support, like to the spear of his great prototype: -------------"to equal which, the tallest pine Hewn fom Norwegian hills, to be the mast Of some great admiral, were but a wand He walked with, to support uneasy steps Over the burning marl." And should it fall to your lot to encounter, in the ranks of the pro- fession, some such mighty genius, who, bent on evil, would sacrifice a brother to gain a point'; would prowl in the dark ways of stratagem to prey on those who had confided in him; would let lose the hell- hounds of detraction upon you, and instigate others to combine to de- stroy you, if you were found not contributing to his elevation. I say, should you find some such collossal fiend in your way, and threatening to blast you, do not be thrown off your guard—take things coolly—treat him civilly—connect yourselves with something great and useful—greater than he—that shall draw public attention to you— and by no means quarrel with him outright, or draw the public gaze to him, as the victimized wag did to Lord Beezley of London, a man of uncommon stature and amplified with broad Quaker skirts, walking up Cheapsideswith towering air.—"Ladies and gentlemen," hecried, running on before him, "make way, make wray, make way, the monu- ment is coming." Revenge or sarcasm may gratify present feelings, but recollect you have higher and loftier aims. There will be but little difficulty in getting along with rivals, who may be either secret or open enemies, if you will act honestly and up- rightly yourselves, and command your feelings. Their malice will sooner or later turn to your account. Your position is one of strength and security when you can lay your hands on your hearts, before high heaven, and feel and say that you have not been aggressors. This is the position you must hold in relation to your medical brethren, at all hazards. I pity the one who can hold any other. 20 But, 1 have said enough to guide you, perhaps to perplex you.— The inducements the profession holds out are known to you, and have, doubtless, been well considered. The incentives to professional em* inence—the honors and emoluments, usefulness and enjoyments of the profession, are all before you. You know them all. You need noth- ing said to quicken enthusiasm now. The only danger is that the cares of the world may hereafter dampen it. But, you know it is writ- ten for the christian's instruction, "he that putteth his hand to the plough and looketh back is not fit for the kingdom of heaven."—So it is in medicine. Then touch not, taste not, handle not any other business, and despite all the disagreeables, for there are these, you will come to love with joyous rapture, this great and good and noble profession.— You will compare it with the other occupations of men, and weep over those who toil for cent per cent, and whose minds can be satisfied with such returns, while you are deriving from your daily avocations, the most rational, heart-felt and soul satisfying enjoyments. You will be Continually contrasting your happy lot with those who work hard for a bare support, with such meager intellectual enjoyments arising from their handicraft routine of duties as can but claim your pity.—And your hearts will yearn with sympathy for your kind, and you will feel yourselves raised above the little petty strifes and jealousies of the world, and the paltry hopes of gain, as you partake more and more of these deifying refreshments, and find your ardour becoming insatiate, "as if increase of appetite had grown by what itfed on."—Your God- like aspirations to be foremost in every benevolent work for the mitiga- tion of human suffering, shall finally place you in the van-guard of the philanthropists of the age, and benefactors of the human race. Well, so be it. The great WEST—an ample and inviting field— * with its many pressing wants; its annual sickness and suffering; its credulity and quackery, in chaotic confusion, waiting the impress of your touch of order, is before you and around you; '^Where wilds immeasurably spread, Seem length'ning as you go." You see it stretching even now, westwardly, over the heights of Chippe- wran, & threatening, southwardly, the annexation of the polished halls of Montezuma. You see Europe, pouring its hundreds of thousands, annually, into this land of freedom and fertility. You see it embracing a coast on the Pacific as great as on the Atlantic Ocean, and the wealth 21 of China and of India about to be poured into its broad lap from this direction. For look you, and behold the anxious, restless spirit of the age, already impatient to wed the two oceans with iron bands for trafic, and wires for intelligence, that the star of empire and of wealth may westward speed their way. Your hearts beat high with ardour now. You are building castles in your imaginations, no doubt, of proportions worthy of your great country, and of the present age.— / You are making vows, perhaps, of such devotion to your profession, as would shame the lover. Like true knighterrants, you swear to be constant and faithful till death. It is well. Keep your hearts and minds awake to the joys your imaginations now picture in store for you in the distance. They are attainable. They will be real and substantial. They will be enduring. To be continually relieving human suffering—rescuing victims from the grave—curing disease—advancing in knowledge and attaining quali- fications fitting you for the high honors and stations of the profession, are pleasures of the highest order you can enjoy on earth, and akin to the joys of heaven. Go—proud young Gentlemen—secure and enjoy these highest boons. Let not the dull realities of life engross and divert you.—Let not pros- perity warp you. Time, patience, and perseverence, will bring the fruition of your hopes. And wThen you can look back on twenty years and more of profes- sional life, with honors and laurels crowning your heads, and wisdom and experience enthroned within; when the voice of him who now attempts to inspire you is hushed, perhaps, in the slumbers of the grave ; when all of those on whom you have relied for instruction have passed, perhaps, from this institution, and from this life; and when the little towns where you may settle, on the ultima-thule of civiliza- tion, perhaps, shall have grown to be cities, having their medical schools and hospitals, with yourselves in connexion ; your thoughts, if not your hearts, may, perchance, in some musing mood or reflective moment, revert to these scenes. The Lyred-Muses of your day-dreams, when unconsciously discoursing over the harmonious themes and brilliant passages of your useful lives, may, perchance, strike some chord that shall wake up recollections of your Alma Mater, and of this little bright and classic town of Laporte—clustered on the sunny side of Clear Lake; resting on the bosom of the prairie land like a gem of pearls on 22 beauty's brow—and the echo of the distant music, bring to your re- membrance the joys of this day, and the spirit of these times; when: " Fleet as the tern that wakeful springs From stunted beech or blighted willow, Our little Thulia spreads her wings, And off she skims across the billow. A fairer morning o'er the face Of wintry region never smiled, And 'mid the ripples at its base, The stormy cape itselflooks mild. With hopes elate, and hearts that spurn All thought of fearing wind or waves, The eager ones from hither turn, To check the fill of human graves." FEE BILL 5 Adopted by the Members of the Medical Society of Illinois, at a meeting held in Spring- field, Illinois, January, 1840: Ordinary visit in town, gl 00 Visit in country, distance under 4 miles, 2 00 More than four miles—per mile, 50 The above rates to be doubled* at night. Special visit at a time appointed by the patient or friends, after the first visit, 2 00 Verbal advice, 1 00 Written advice, $1 to 25 00 E very dose of medicine, 5 0 First visit in consultation, 5 00 Subsequent visit in same case, 1 00 Visits in town after 9 P. M. to be con- sidered as night visits. Visits after 5 A. M. in summer and 7 A. M. in winter to be considered as day visits. Visits after dark in the country to be considered as night visits. Necessary detention in ordinary cases after the first hour—per hour, 50 In cases of Parturition, after 10 h.—per h. 50 Unnecessary detention in any case—per h. 1 00 In all surgical cases the charge for subse- quent attendance to be according to the time occupied and trouble incurred. Case of natural Parturition, 5 to 10 00 Consultation in case of Parturition, 5 00 Any indisposition of mother or child af- ter the second day of confinement, the charge for attendance same as ordin- ary visits. Vaccination. Bleeding, Extraction of Tooth, Dividing Frenum, Reducing Fractures, Reducing Luxations, Passing Catheter, Lithotomy, Amputation of Leg or Arm, Amputation of Finger or Toe, Extirpation of Tumor, Trepaning, Cataract, Aneurism, Hernia, Reduction of Hernia, Fistula in Ano, Fistula in Lachrymalis, Hare Lip, Hydrocele, Ascites, Syphilis, Gonnorrhea, 1 00 50 50 2 00 5 to 10 00 5 to 30 00 1 00 100 to 200 00 25 to 100 00 5 to 20 00 5 to 50 00 25 to 100 00 50 to 100 00 100 to 200 00 25 to 100 00 5 to 10 00 10 to 30 00 15 to 30 00 10 to 30 00 5 to 20 00 10 to 20 00 20 00 10 00 Extracting Placenta, 5 to 10 00 Resolved, That any agreement entered into between a member of this Society and an- other person, in relation to any fee or compensation for services, be sanctioned by this Society ; also, That hereafter we expect all medical bills to be settled, at farthest within the current year in which the services were rendered. In order to exhibit uniformity in our rates of charges, we agree that no entry shall ever be made in our account books of lower fees than those contained in the foregoing table. If in any case however, we should have reason to believe that the patient cannot pay the full amount without serious inconvenience, a deduction may be made at the end of the year, at the time of rendering his bill, or at any other time. But the fee bill at present established being based on a just consideration of the important services which the Physician is called on to perform, wo feel it our duty, and we shall conform to it in our charges whenever the circumstances of our patients are not such as clearly to forbid- tL Signed JOHN TODD, President C. F, HUGHES, Secretary. V Wz. !?H 1