AS i ADDRESS BEAD TO THE MEDICAL CLASS AT DARTMOUTH COLLEGE, DECEMBER 1, 1818. R. D. MUSSEY, M. D. PROF. THKOR. ARB PRAC. PHYS. AND OBSTKTi HANOVER, N. H. PKINTED BY CHARLES SPEABj 1818, Hanover, Dec. S, ISIB, Dear Sir, IN behalf of the Students of the Dartmouth Medical Insti- tution. we are happy in rendering you our sincere thanks for your instructive and interesting Jjddress, made to the Class the Ist inst. Desirous that the principles therein inculcated may guide u's in all our intercourse with our fellow creatures, and in compliance with the unanimous wish of the Class, ice so- licit the favour of a copy, for the press. ELAM STIMSON, AUSTIN GEORGE, JOSEPH TOZIER, Committee. Prof. R. D. Mussey. Gentlemen, The Address was hy no means written ivith a view to publication, and an application for it was wholly unexpected ; but after some hesitation, I have concluded to submit the copy, R. E. MUSSEY. Messrs. E. Stimson, A. George, J. Tozieh. V, College, Dec. 5} 1819> ADDRESS. Gentlemen^ HAYING come to the close of. that part ot my course which more specifically embraces the Theory and Practice of Physick, I am disposed to offer you a few suggestions relative to the duties which Physicians owe to themselves, to their med- ical brethren, and to societij. Allow me then, gentlemen, to ask, Are you pre- pared to enter upon the practice of Medicine ? To some of you, possibly, the profession may ap- pear like a spacious and delightful plain, along which, after a little preparatory training and dis- cipline, each may push his courser with a velocity and to an extent suited to the most ardent ambition; toothers, it may seem like the abrupt side of a lofty mountain, the ascent of which is difficult and dangerous, winding among steeps and precipices, which strike the traveller with dismay. But let me tell you, it is not like either; it more nearly re- sembles a field, of an extent which has not been estimated, filled with objects which every moment arrest the eye and solicit attention, yet opposing no insurmountable barrier to an habitual progress. The sentiment is, that eminence in the profession is at- tainable; and if the path to it be admitted to lip » upon an ascending surface, yet the ascent is regular, and the course, ‘right forward/ Another senti- ment which cannot be too strongly impressed, is, that a young man who having submitted to the prescribed rules of a three years course of study, and being invested with the insignia of Medicine, casts his eye upon the world in search of a theatre on which to display his skill, is but just entering the outer porch of his high profession ; he is still a stranger to ‘the fair proportions and the finishing,’ the magnificence and the beauty which reign with- in. The young practitioner takes upon himself new relations, and assumes high responsibilities ; the lives of his fellow men depend on the decisions of his judgment, and he ought to feel that he is com- mencing anew the study of his profession under circumstances of momentous interest, and with in- citements to exertion too strong to be resisted. A knowledge of our profession, like the science of natural philosophy, is comprised in a knowledge of those facts which come within the ken of actual observation and experiment; it is not to be acquired in a seclusion from the scenes of external nature, nor in abstract speculations upon the possible prop- erties and essences of things, from which specula- tions result certain general principles of so exten- vsive application, as to include the whole range of physical phenomena. General principles in any science are nothing more than so many collections or groupes of indL 5 vidual facts thrown together in conformity with cer- tain leading points of resemblance. In the pursuit of medical knowledge then, the same stern, indefa- tigable and minute attention to facts is necessary, which is found to characterize the successful pur- suit of other departments of physical science, and the same caution and incredulity in the admission of general principles, without an entire conviction of the genuineness of an adequate number of facts on which they are professedly founded. It is not by a single effort, by reaching forth the hand and making an exertion grasping,thsit we are to expect to gain a knowledge of Phy sick; nor is it by the exercise of a faculty which many conceive to have been born with them, a faculty of guessing out the nature of the disease and the appropriate remedies, that any one can justly expect to become a distin- guished physician.—No ; he must submit to a much slower process ; he must study nature piecemeal; he must look faithfully, attentively and long upon her minute operations, and suffer no fact however trivial it may seem, to escape his distinct notice and recollection. For as he is incapable of estimating the bearing and influence of those facts which have not been associated by any marks of general resem- blance, and as he is aware that facts which at first view seemed wholly insulated, have often led to important discoveries, he will treasure up and re- tain with care those circumstances which might pass unnoticed by the superficial observer. 6 The science of Medicine including; all its branch- cv is. Anatomy, Physiology, Cbyraistry, Pathology and Therapeuticks, already presents an assemblage of facts, appalling indeed for minuteness and vari- ety; but discouragement should not be allowed a moment’s place in the breast of the votary of sci- ence. There is nothing unconquerable in the vari- ety or number of the items which at present consti- tute the sum of medical knowledge ; and there is good reason to hope that he who avails himself of what is already known in the profession, will he able to advance its interests still further, by adding something valuable to the general stock collected by others. Knowledge once familiar is liable to escape from the mind, unless the parts of which it is composed are occasionally called up and reviewed in the order in which they were originally placed there ; hence the necessity of occasionally re-examining with care, those subjects, and of recurring to the same treatises we formerly studied. But while we fre- quently peruse our old books, we are bound to extend our inquiries in search of new facts in more recent publications, and carefully to compare them with the results of our own observation. The phy- sician who reads his books attentively, fails indeed of the pleasure of making discoveries which others had made before, but lie avoids the mortification of being told that he has found out nothing new. Without devoting a due proportion of time to booksy 7 ho physician has a right to look for eminence. He moves in a sphere too limited. The materials on which his mind can act, are too scanty to admit of his acquiring a full and comprehensive view of his profession, even though he he a faithful observer of all the facts which come within his notice during a long life. If placed in a situation to command a good share of medical practice, his observation and experience may furnish him with much valuable in- formation ; but he may spend months, nay years in establishing positions which might have been made known to him by the reading of a single day, while a vast quantity of information which his limited means of observing could not furnish, and which might he found in books, is still hidden from him. A gentleman of the faculty once requested me to call at his house in company with another physi- cian, and examine a quantity of blood he had that day taken from a patient’s arm ; it exhibited, he observed, some remarkable appearances which he had no doubt were new, and which might indicate a morbid condition in the patient not perhaps capa- ble of being understood,till the extraordinary symp- toms to which it might give rise, should unfold its nature. On examining the blood we found nothing fit to excite astonishment; its remarkable appearances were a thin buffy coat of moderate tenacity, and of a hue peculiar to a thin buff. Had this physician been acquainted with the treatise on the blood, by the celebrated Hunter, he would have spared him- 8 self the trouble of calling in his medical brethren to witness his discovery. There is some choice as to the method of reading upon medical subjects. If we have ever so much leisure for reading, it is by no means the most use- ful course, to take up one octavo or quarto after an- other, and read it through precisely in the numeri- cal order of its pages. A much better mode is, to determine upon a particular subject, to read what every valuable author has written upon this subject, to fix well the peculiarities of each in the mind, either by making minutes or by careful reflection, and after having bestowed upon the subject that attention necessary to give us a view of it in some degree our own, to write an essay upon it which shall include the opinions we have found in books, together with those which may have occurred to ourselves in the course of the investigation. This method faithfully pursued, will give a man a commanding view of the book knowledge of his profession. He may not indeed expect that it will suddenly insure him a reputation, but in a few years lie will find himself more than compensated for his labour, I could name a gentleman now at the head of the profession of the law in the state where he re- sides, who was fifteen years pursuing his studies in this way, and at the same time engaged in full prac- tice. Thus disciplined, how differently does a man appear from him who for a long life has been con- fined to a limited sphere of observation; and who has 9 read nothing, or who abandoned books when he commenced practice. • A physician once boasted to me that he had not read so much as the contents of a small octavo volume for five years, that he was at no loss for a remedy in any case of disease, and that his success in practice was, he believed, greater than that of any physician of his acquaintance. His neglect of books seemed to have contributed greatly to his entire confidence in his own skill and supe- riority. Is not this account of himself, a correct picture of too many of our medical practitioners ? It is not enough that we make ourselves acquain- ted with the syslematick and standard works in our profession ; we should avail ourselves from year to year, of the progress the science is making among our neighbours and abroad. This is to be ac- complished by reading regularly the best period- ical publications. From the discoveries, improve- ments and suggestions contained in Journals, and the record they exhibit of the progress of medicine in different countries, we receive fresh impulses to exertion for the promotion of its interests and the extension of its blessings. A medical journal is to our profession what a newspaper is to the science of politicks. If ably edited, each number of it be- comes a periodical stimulus to the mind ;it revives an interest in those questions which relate to the elements of civil society, and renews the zeal of pursuit among those objects which elevate the rank and promote the felicity of our species. 10 the careful perusal of medical books must not, however, be allowed to interfere with a spirit of scrutinizing and minute observation. Indeed, may I not say, that with every philosophick mind, a love for books tends to foster and strengthen the faculty of observing the phenomena of nature ? After hav- ing read a well written essay upon a subject, we are prepared to observe with additional interest, the phenomena relating to it, which may fall under our notice. Kven the diversity of opinion among medical Writers, a circumstance sometimes offered as an objection to books, must stimulate a mind bent on the acquisition of truth, to increased vigi- lance of observation. The question has been put, diow shall it be as- certained, of the writers on medical subjects, among whom there is a difference both in opinion and in the statement of similar facts, which has the strong- est claims upon our belief?’ In answer, it may be said, that there is a truth-telling manner in books as well as in conversation, which can scarcely be mistaken. A correct statement of facts is apt to be made in simple and plain language ; the author knows he is telling truth, and this is sufficient for Ids purpose, this puts him at ease among his read- ers. But when a writer designs to palm upon the credulity of bis readers an incorrect statement, he labours to be believed ; he knows bis word is liable to be questioned, and hence be makes positive as. sertions in strong or unqualified language. To render, however, a mairs writings valuable, it is not merely necessary that lie should avoid the intentional raistatement of facts ; he exhibit a talent for philosophiek observation, and in relat- ing what is professedly the result of his experience, he should evince that he is capable of seeing phe- nomena just as they are, of describing them just as he saw them, and of making from them those legiti- mate and important inferences which are suggested by an enlightened philosophy. A careless habit of observing facts, a loose mode of relating them, and an indolent attempt to deal in vague and general propositions, are uninteresting at the outset, and soon occasion disgust. That class of medical writers whose object is to support a new or favourite theory, are not greatly to be relied on in their statement of facts. Al- though many of them appear to feel no special re- pugnance to truth, yet they are scarcely capable of following it as a guide. A writer of this sort, al- ways enthusiastick and glowing, sees objects as through a prism, fringed with the beauties of the rainbow ; and in his descriptions, always gives them a colouring not their own. Bent on the estab- lishment of a suddenly conceived hypothesis, he lets loose his fancy as the most suitable faculty of the mind to accomplish his object. But fancy, thus bidulged, with the power of a telescope can magni- fy facts to any necessary dimensions ; or like the same instrument inverted, can reduce them to lillk putian insignificance, whenever the favourite doc- trine requires for its support this sort of metamor- phosis and accommodation. The conceits of a maniac who fills his hair with straws and feathers for a crown, are not wider from truth and coinmon sense, than are the visionary speculations of some writers in medicine from the dictates of sober and sound philosophy. ‘One of the most useful exercises of reason/ says: an energetick writer, ‘is to ascertain its limits and to keep within them ; to abandon the field of con- jecture, and to restrain itself within that safe and certain barrier which forms the boundary of human experience.* Were this the only mode of investi- gating medical subjects, were a spirit of accurate observation universally cultivated, and were every writer to confine himself to the faithful recital of phenomena, and to those deductions which most obviously result from them, it would be impossible to predict the rapidity of the progress which would thus be communicated to medical science. To the introduction of the Baconian philosophy, we may indeed chiefly attribute the progress which medicine has made within the last two hundred years, a progress greater than it can boast of in the preceding two thousand years ; yet the science Las never been entirely freed from the loose modes of thinking'adopted by the ancients ; and there are writers of the present age whose claims to respect from an enlightened philosophy, are not greater than those of a Peripatetick declaring tlie abhor- rence of nature to a vacuum, or of a Cartesian borne on his whirlpools of ether. Of the books in our profession, I know of none that for the philosophick accuracy with which facts are fidelity with which they are detailed and the profound reflections with which they are ae- aecompanied, can claim a higher rank than the wri- tings of Dr. Wm. Heberden, and Mr; John Aber- nethy. A stern regard to truth, and a power of mak- ing just so much of their subject as good sense al- lows, and no more, are visible in every page of these great men ; and the reader is as well satisfi- ed with their statements of phenomena as if he had been the original observer of them, and reposes with nearly the same •confidence upon their reflections and inferences as if he himself had made them. A familiar acquaintance with all that is known in physiology, is of great importance to a medical man. The power of readily recurring to every well established physiological fact, has a salutary influence in repressing idle conjecture, and often enables the physician to put to flight those vague notions which are founded in loose analogies, or which start up in the capriciousness of fancy, and which he may but too frequently meet with in him- self and among his brethren. The physician should also study with care not only in books but by observation, the phenomena «f disease as they exist under the diversified influ- 14 ences of climate, of constitutional peculiarity, or' of regimen, whether it regard food or drink, cleanli- ness or clothing, air or exercise. The diagnosticks and habitudes of disease cannot be too strongly im- printed on his mind. This kind of knowledge in- spires him with a confidence as to the general course of a complaint, increases his promptness in fixing upon the treatment, and gives him a visible superi- ority, which is evinced by the connected and phi- losophick view he takes of the subject, and often fey the effect of the remedies he prescribes. An acquaintance with the materia medica is of no less importance than a knowledge of the distin- guishing signs of disease. The effects of the vari- ous articles employed as medicines when given by way of experiment to persons in health, their usual effects in disease, and their uncommon or anomalous effects occasionaly observed, and which may have occurred under the influence of peculiarities of con- stitution or numerous incidental circumstances ca- pable of being estimated by attentive observation j the average doses of the different medicines, espec- ially of those which are the most active and power- ful, are points of knowledge which should be as familiar to the physician as the roads he travels. While on the one hand we study first the phenom- ena of disease and then the appropriate remedies, it is useful on the other, to learn the qualities of an article of the materia mcdica, and to have associat- ed along with it in the mind, the different diseases in which it may have been found salutary- To every physician who designs to reach the greatest possible usefulness,it is important to keep a journal of all extraordinary cases ; it is also impor- tant among the cases of ordinary occurrence, to note down with care all those deviations from establish- ed phenomena which he may observe, and which may lead to inferences different from the generally received opinions of the faculty. The justly cele- brated Heberden kept a note book in which he minuted the phenomena of disease and the effects of remedies, as they daily came within his notice. At the end of each month he arranged his observa- tions under their appropriate heads. The materi- als thus collected from fifty years practice under- went a revision and condensation, and at last as- sumed the form of his invaluable Commentaries on the History and Treatment of Diseases. If the practice were universal, of thus noting the phenom- ena which fall under the physician’s eye, how greatly would it tend to promote a habit of attentive observation, how much would it enable him to profit by his own experience, and how large an addition would it make in a single century to the stock of medical knowledge. With minds thus disciplined to habits of faith- ful reading, of attending to facts as they occur within the sphere of your observation, and of re- cording them and reflecting on them without a bia»* from preconceived principles or hypotheses, may you, gentlemen, grow up to eminence and great usefulness in the dignified profession you have chosen. On the duties which physicians owe to each other, and to society, I must necessarily limit my- self to a few observations. The remark has often been made, that physi- cians are seldom heard to speak well of each other. This remark is usually accompanied with the que- ry, Why is it that a spirit of jealousy and hostility is so widely diffused among the faculty of medicine ? In answer to this, it would not be correct to say that the study and practice of the profession have a natural tendency to narrow the sphere of intellec- tual vision, and to foster the mercenary propensities of our nature ; on the contrary we may fairly main- tain that the study of medicine in its numerous branches tends greatly to enlarge the scope and comprehensiveness of the mind, while the practice of the profession gives frequent and strong impulses to the feelings of humanity, and promotes a love for the sweets and blessings of social life. May not the pride of opinion afford a clue to the solution of the question ? Medical men have not the forms, statutes and precedents which guide the gentlemen of the law ; the established principles of their profession are fewer, and perhaps of morelim. ited application ; and their opinions, in a great pro- portion of cases among the sick, must rest on evi. deuce in its nature doubful. It is not difficult to •Conceive that two opinions made up from numerous 17 items of evidence, all or most of which belong td the class of probable evidence, should vary accord- ing to the habits of association and thinking of their authors. Indeed it is scarcely possible, under sucli circumstances, for two men to form opinions which shall correspond at all points. We are not apt to respect an opinion very different from our own, if it be formed at the same time and from the same materials, and especially if its author be inca- pable of telling us why he has come to his result. Accordingly, as many good physicians are not in the habit of analyzing the processes of their minds, they are utterly unable to unfold the course of re- flection which led them to a particular decision. Any attempt to explain this is unsuccessful. This gives the opponent a secret triumph, and confirms him in the opinion of his own superiority ; while the other perhaps, attributes his want of success ia making himself understood, to obtuseness of intel- lect, or a deficiency in that power which enters in- to the composition of a great mind, and which ena- bles it to glance at objects and arrive at conclusions with the celerity of intuition. Hence the disrespect, if not contempt, so often felt for the opinions of others, and the slowness to acknowledge their claims to a respectable standing in the profession. Aware, therefore, that circumstances to which we are daily exposed, tend to produce in us a dis- position to treat as whimsical or absurd,the opinions 18 of physicians of equal pretensions with ourselves, we should esteem it a duty to be constantly on, our guard, when speaking of their talents or attainments. I do not recommend that kind of caution which says nothing, but by nods or intimations would be understood to be afraid of telling what it knows ; but that marked regard to character which is willing to state an obvious defect,and which is also unwilling to pass over a single trait of excellence or merit. In this injunction religion and policy unite. It is no less the policy than the duty of a physician to treat the characters of his medical brethren with due respect. By this course he acquires a reputa- tion for candour ; and while, by misrepresentation and falsehood, his rival is perhaps attempting his ruin, he passes silently and surely on to respecta- bility and eminence. A repugnance to consultation is too often mani- fest among the faculty. But if a consulting visit to our patient from a physician whom we cannot respect be disagreeable to us, it may still be our du- ty to comply with the wishes of the patient or his friends, in those cases where we can assure our- selves of being treated with civility. Consultations tend to increase rather than diminish the confidence reposed in the attending physician ; and in difficult and dangerous cases, a consultation by dividing the responsibility, gives relief to his feelings, while it gratifies the friends or family of the sick. 19 The objection to consultation which arises in the mind of the attending physician, seems often to be founded on the notion of superiority of skill in the consulting physician,which the very proposal appears to carry upon the face of it; bat in many instances the proposal embraces no such opinion. Among anxious friends, the reasoning often is, ‘two are better than one,’ ‘in the multitude of counsellors there is safety.’ We may therefore consider a desire for consultation as resulting from a solicitude to do every thing which circumstances will admit, for the recovery of the patient, and not as containing a reproach upon our skill. There are instances however, in which an unwillingness for consultation springs from a conscious inferiority, and from fear of tiie exposure of injudicious or hurtful practice. In cases of consultation, it is generally proper that the conversation should be between the physi- cians themselves, and not within the hearing of the patient or the family ; and on these occasions, it is the duty of the attending physician to make a full and fair statement of the case, with an account of the course of practice adopted, and the effects of medicines, the bad effects as well as the good. This gives the consulting physician a better oppor- tunity of making up a useful opinion. We have too often occasion to notice on the part of the attending physician, a disposition to conceal some circum- stances which might materially influence the con- 20 elusions of the other ; and also a solicitude, by as- signing a wrong cause fur certain unfavourable symptoms, to draw his mind from the contemplation of those facts which might lead to a suspicion of mismanagement. This disposition to assign the wrong reason for a thing, is by no means confined to the faculty of medicine ; it is found more or less in all classes of men ; and although it cannot conceal itself from common sagacity, not a few persist in submitting to. its impulses. Truth, gentlemen, an undeviating regard to truth, is as necessary to physicians as to any class of men, and it should be as much your study to arm yourselves against every temptation to violate it, as to cultivate a knowledge of your pro- fession. If you ever find your honesty, fidelity and candour, by a gross and unexpected perversion, made the basis of a charge against your morals or your skill, by an intriguing, unprincipled, or profli- gate brother, you may have a right to withdraw from him all medical intercourse, but you have no right for a moment to quit the path of truth, in or- der to meet him on his own ground, or combat him, with his own weapons. When you are placed so near to a physician that the professional visits of both fall promiscuously among the same population, it is important to have a full understanding and agreement relative to the system pf charging for visits, advice, and medicine^ 21 When once you have come to such an understand, iug with a brother, never deceive him, nor attempt by undercharging, to fasten upon him the character of a mercenary or exorbitant man ; and should you unexpectedly find yourself stung by his disregard of the engagement, you are under no further obli- gations to him, except to do him good when you can, and to pray for him. If his duplicity gain him a temporary prosperity, you have no occasion to re- pine ; your course is plainly marked out. Read your books, observe phenomena, carefully attend upon the sick, discharge all your duties with a con- scientious regard to the rules and sanctions of re- ligion, and in a few years you cannot envy him. As a member of the great family of man, the phy- sician owes certain duties to society. The first of these duties is, that he devote himself to his profession. By this, he is prohibited from en- gaging in projects of pecuniary speculation, which might materially interfere with habits of reading and thinking on medical subjects, and the regular exercise of practical skill. He who com- mences the practice of medicine, virtually engages his time and talents to promote the interests of the profession and the cause of humanity ; and when the pledge he thus proffers is accepted by the com- munity, he is bound to pursue his profession as his exclusive business, in order that society may derive the greatest possible benefit from bis labours. From a faithful exercise of his professional tal- ents he has a right to expect a comfortable living ; but beyond the limits of a competency or a respec- table property he may not extend Ins ambition. When he recollects that ‘he who makes hasle to be rich shall not be innocent/ that the avails of his practice will ultimately ailbrd him a competency,and that all his talents and his time are called for by his chosen employment, lie can have no adequate motive lor stepping out of it and plunging into speculations of business to which his mind has not been trained, and which might subject him to disappointments and losses, and perhaps disgrace. The same obligations to society will forbid him to seek political promotion. How degrading to his profession as well as unjust to his employers, for a physician to accept the commission of Justice of the peace, a place in the Legislature, or even a seat in Congress. Disciplined to the investigation of phys- ical phenomena, and to the details of the sick cham- ber, he is not prepared to shine at the forum, is not schooled to the discussion of those questions which relate to general polity, nor to the display of that eloquence which can sway the high councils of a nation. He can with propriety only give his vote, and this, a man of no attainments in medicine, can do as well. Is he a lover of philosophy as he should be ; does he delight to contemplate the beauties and wonders 23 of nature, let him continue to investigate the sub- jects connected with his profession; here he will find scope for all his powers, and ample opportuni- ty for the exercise of wonder and admiration at the skill and power of Him, ‘whom,7 to adopt the lan- guage of another, ‘no magnitude can overpower, whom no littleness can escape, whom no variety can bewilder ; who moves every particle of blood which circulates through the veins of the minutest animal, and all this by the same omnipotent arm that is abroad upon the universe, and presides in high au- thority over the destiny of all worlds.’ You, gentlemen, have chosen a profession which can place you in a commanding attitude in society, and give you an influence far more extensive than the sphere of your personal intercourse. When therefore, you commence the practice of medicine, it will be optional with you whether to give your influence in aid and support of those pillars which prop the fabrick of human society, or whether you will submit to become the reptiles who attempt to undermine or gnaw them down. Duty to your- selves, to your profession, to society, to your God, demands your exertions on the side of morals and religion. l)o you find yourselves persecuted by open ene- mies, cheated and abused by supposed friends, or deserted and calumniated by those from whom you merit nothing but gratitude : the explanation is easy 5 24 you live in a death struck world, its atmosphere is poisoned by the exhalations of sin, its moral beau- ty is withered, its verdure blasted. But whiles with solicitude and pain you survey the exten- sive ruins before you, Revelation kindly whispers, ‘a miracle has been wrought, the trees of paradise shall grow again, and this world shall live in all its primitive glory.’ To the gentlemen of this class I most cheerfully express the sense I entertain* of the respectful at- tention, the order, and zeal in the pursuit of pro- fessional knowledge, which have marked their con- duct at my lectures. My wishes for your prosper- ity and usefulness, gentlemen, accompany you through the fatigues and anxieties of professional exertion ; and when each of you* after a long life of eminent services rendered to the profession of med- icine and to morals and religion, shall have sunk to the grave, may the traveller as he passes your tomb, point and say, ‘there lies the dust of an honest man, of one who loved truth, acknowledg- ed his high responsibility to heaven, and was faith- ful to himself, to his patients, to society, and to hie God.’