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^INTRODUCTORY  LECTURE
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NOVEMBER 6 th, 1S50
By JOHN WARE, M.D.,
HERSEY PROFESSOR OF THE THEORY AND PRACTICK OF PHYSIC IN HAR\ \RV UNIVERSITY.
    /      BOSTON:

DAVID CLAPP, PRINTER....184 WASHINGTON STREET.
Medical and Surgical Journal Office

      1851.
 
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SUCCESS IN THE  MEDICAL PROFESSION.
INTRODUCTORY   LECTURE
DELIVERED AT THE
MASSACHUSETTS MEDICAL COLLEGE,
NOVEMBER  6th,  1850.
            By JOHN WARE, M.D.,
HERSEY PROFESSOR OF THE THEORY AND PRACTICE OF PHYSIC IN HARVARD UNIVERSITY.
             BOSTON:
DAVID CLAPP, PRINTER....184 WASHINGTON STREET.
          Medical and Surgical Journal Office.
                 1851. 
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INTRODUCTORY   LECTURE.
   I am forcibly reminded, gentlemen, of the rapid passage of time, by find-
 ing it again my duty, in the order of rotation, to become the organ of the
 Faculty in addressing the class at the beginning of another course of lectures.
 The topics which suggest themselves, for such an occasion, are sufficiently
 obvious, but, unfortunately, are not  very various.  One is therefore fear-
 ful that he may become tedious and distasteful, because he is obliged to
 treat of subjects and  utter sentiments, which are repeated many times
 every  year to  many medical classes.    He has, however, only to recol-
 lect, that  though the materials of such a discourse may be stale to himself
 and to some small  part of his audience, yet to  the  greater part of it
 and to that part for whose advantage it is  intended, everything  may be
 new, and  any topic, if properly treated,  may be made  useful.
   In a profession like ours, the avenues to which are always filled by eager
 and aspiring competitors, the young man naturally looks forward to the day
 when  he  shall himself take his  place among  them.  He reflects,  too
 with some anxiety, upon his chance for success amidst the crowd ;  and
 he would be glad to learn what the  means  are by which  he may secure
 it.  The  inquiry constantly  forces itself upon him—What are the ele-
 ments of success ?   How  am  I to attain that which is the ultimate ob-
ject of my exertions, the confidence  and the patronage of mankind ?
   Is it best that this  inquiry should thus engage the mind of the student ?
 He will be told by some that he is not to think of the  future, but  of the
 present;  that he is to qualify himself now, by a sedulous attention  to his
studies, for the  duties  that will by-and-by devolve upon him; and that,
if  he is faithful to these, he may be certain of his reward hereafter.   He
is told to take  care of the present, and that the future will take care of
itself.  This, like many other popular maxims, is specious rather than solid.
The advice it conveys, taken without much qualification, is not founded
in  wisdom.  To understand the  present and act well  in it, we must 
4
know something of the future, for  which it is  to  prepare us.   There is
much, as I think, in the right  direction  of professional  study, and  much
in the character and habits, moral  and social, which the  student forms,
that will have a direct influence on his success as a practitioner.   This
it is all important that he should be convinced of in an early part of his
career.   I  propose, therefore, to devote  the  time allotted to this dis-
course to a consideration of  the Elements  of Success in the Medical
Profession.
   But let me,  in  the first place, explain what  I  mean by success.   I
do not mean merely getting rapidly into a large practice and  receiving a
large income.  This is  desirable.   But it may be  done  without what I
understand by the best success.  Where this is done rapidly, it is seldom
done permanently.  True success in  medicine is that  which  gives to a
man__after   a  reasonable probation—a probation which affords  time
for his qualifications  to  be really appreciated—the entire  confidence of
the circle in which he lives.   This confidence is always a  plant of slow
growth.   If it  spring  up in  a night, it  may wither in a night.  Those
qualities  which  afford a substantial foundation  for it, cannot be  made
known, cannot be duly appreciated, in a short period.   The same is true
of any vocation—most of all  is it  true  of  ours.   A suddenly acquired
reputation and  practice  can only be the result of qualities of a super-
ficial kind, which attract and dazzle at  first,  and which usually captivate
a class of patients who are  themselves  superficial and generally fickle.
In  every community there is such a class, caught by  every new preten-
sion in the medical art.   Large promises and an assured air of self-reliance
afford a certain passport to their favor.   But their favor  is transient.   Him
whom they  thus seek  and trust before they  can know  him, they forsake
as  lightly.   He has not  the qualities which  ensure a  confidence  worth
keeping—and they have not the character which enables them to place a
confidence worth keeping in anything.
   No man  who embarks his lot for life in our profession—no man who
intends to practise it with a  view to  its highest  usefulness to others, as
well as to his own best advantage, should  aim at  the  cultivation of the
qualities that can only gain him a patronage  so worthless  and evanescent
as this.  I believe, gentlemen, I  may say with truth, that everything re-
lating to your studies,  your character,  your  habits, your manners, your
social  and professional  intercourse, may have   an influence more  or
less important  on  your prosperity  in  the profession you have chosen;
and my present purpose is to offer a few suggestions to aid in preparing
you to acquire that sort of confidence which  I have described as the only
sure foundation for permanent success. 
5
  Of course I shall be expected  to say that  a thorough knowledge of
medicine  is of the first importance, and  assuredly it  is so.  But this
general statement requires  some  qualification.    Medicine  embraces a
vast field of knowledge.   To go over the whole of it is impossible, even
in a  long life.   The pupil can  only begin  its  cultivation.   All this
knowledge is of value ;  but all is not of equal  value.  All has  some
connection, but  not an  equal connection, with practice.   Now the main
purpose  of the  study of medicine  with  most of us, is to enable us to
treat disease.  This is the ultimate  object, which  is  to be kept in view
at every step.  It is for  this end  that  the science of medicine  exists—
for  this that  the profession  exists.   This is never for  a  moment  to be
forgotten.  No  doubt there are some physicians whose  aim is different
—to whom practice is  a secondary concern.  They mean to acquire a
great proficiency in some particular department.  They mean to devote
peculiar attention to anatomy, to pathology, to organic  chemistry, to the
microscopic study of organic forms.   These are all  useful  pursuits, and
they all have a useful bearing upon practice.  But I am not speaking to
such  persons.  The  mass  of medical students are to  be  practitioners,
and practitioners only.   These are the proper subjects of general medi-
cal instruction.
   This  I  regard as a very  important  point.  It is too often overlooked,
that the final purpose of all  medical study is practice.   The whole circle
of sciences connected  with medicine has been called  into  existence for
this purpose, and their value  depends upon their  connection with it.  I
do  not mean to  say  that they are not worthy to be pursued  for their
own sakes.  They are so, richly. Nowhere are the power, the wisdom and
the benevolence of the Creator more  wonderfully exhibited  than in  the
human body ; and its phenomena  both in health and disease are as well
worthy the contemplation of an enlightened mind  for their own sakes, as
those of chemistry or physics. But it is not as philosophers, as lovers ol* sci-
ence, or even as  admirers of the wonderful works of God,  that we are called
to interest ourselves in these subjects.   It is solely that we  may learn to
treat  disease.  The  direction and arrangement of our studies are to be
wholly governed by this as their final purpose.  Fortunate k is  that  the
attainment of this purpose is not inconsistent with much of  that pleasure
which arises from the  pursuit of  knowledge  for its own  sake.  But we
are ever  to  recollect  that  this is to  hold only the second place in our
regard.
  What, then, is that thorough knowledge  of the  profession which is
necessary to  success ?   A man may know a vast  deal of the profession,
and yet be a very poor  practitioner.   He may be an excellent anatomist, 
6
pathologist, chemist—nay, he may be minutely acquainted with the history
and treatment of disease, and yet  be totally unfit to take charge of a
sinde  patient.   The thorough  knowledge of the profession  to  which
I  refer in this  connection, is  that which  will  make the physician  a
good  practitioner.   The whole course  of his  education—the  whole
course of his thoughts—is to have such  a direction given them as will
most certainly tend to bring about this result.   This makes  it a matter
of nicety as well as of importance, to  select and  give  a  due proportion
to the  different  departments of medical study.   Many things which it
would  be desirable to teach, it is not possible to teach, lest other things,
more distinctly bearing on the main purpose, be crowded out.   The ob-
ject is  to learn so much of each subject as will best qualify a man  to un-
derstand and treat diseases ; and the most proper education for the prac-
titioner is  that,  which selects just such a proportion  of the  knowledge
of each department as will best accomplish this end.
   Hence, though it may  be an  ungrateful task to check  the interest of
the young man  in any  study which  he is pursuing with zeal, yet is he
often in clanger  of expending  a  disproportionate  share of his time and
faculties  on some favorite but limited  subject.   He may acquire so ex-
clusive  a relish  for  anatomy, for chemistry,  for  the  microscope, or for
pathology, as to  vitiate his character  as a practitioner.   Not that these
are useless kinds of knowledge,  but that an  excessive  devotion to them
may impair the practical tendency of his pursuits, and  give them  a
wrong  bias.
   Of course it is desirable that he should be a perfect anatomist. But if he
takes the time necessary to make him a perfect anatomist, he may neglect
what  is  necessary to make him a good practitioner.   After  the  acqui-
sition of a general knowledge of anatomy, accurate as far  as it goes, the
surgeon requires a more minute acquaintance with  the structures connect-
ed with accidents, operations, and surgical diseases ;  and  the  physician,
with those of the organs  which  are  the  principal seats of medical dis-
eases.   It is in vain for the ordinary practitioner  to  attempt  more
than this.
   The same rule  is to be observed  in judging of the amount of atten-
tion to be devoted to chemistry and  pathology.   Not that a man can
know too much of chemistry, or, especially, of pathology ; but that he
may give to them too  much  time in proportion  to that which he de-
votes  to the practical branches.   He cannot know  too much of these,
but he may know too little of therapeutics and  materia medica.  The
point  is  to  maintain  the  due  relation between  the several departments,
and not to become devoted to one at the expense of the others. 
7
   It is a common fault among students, as indeed it is among practition-
 ers  also, to become extremely interested in some particular department of
 inquiry, and to pay an almost exclusive attention to this ; as, for instance,
 to organic chemistry—to microscopic anatomy—to pathological anatomy.
 Such is most likely to be the case with the more ardent and enterprising
 among them ; and their interest is apt to  be particularly engaged by
 some of the elementary branches.   This tendency is not unfrequently car-
 ried forward into professional life, and  some  men  are thus led to devote
 themselves to an exclusive object of interest.  This is useful to  the science
 by  adding to the  common  stock of knowledge.  But the profession is
 benefited  at the expense of the individual.  Hence it has  happened that
 many distinguished men  in  different departments of medical knowledge
 have failed in practice, and that  some who have been very useful in ac-
 cumulating materials which have  made others good  practitioners, have
 been very indifferent ones themselves.  They have been sacrificed to the
 good of the  profession.
   Suppose one to devote himself, for example, to  morbid anatomy.   He
 becomes engrossed by it.  It furnishes him with subjects of interest suffi-
 cient to occupy him completely.   He is likely to withdraw himself  from
 the  study of ordinary diseases, and to find his chief interest in the study
 of those in which morbid changes are to be expected.   He overlooks, or
 regards but slightly, all that  vast  amount of cases in  which structural
 changes are not to be looked for, or in which they are not  cognizable by
 the  senses.  Now  such cases make up  far the largest  portion of those
 which^actually fall  under our notice in every day practice.  Then, too, his
 mind being fixed upon structural disease, and engaged in the study of cases
 in which it is found, he is apt to expect its existence where  a man of com-
 mon observation would not, because he has not become familiar  with
 those cases  in which symptoms like those of structural change present
 themselves independently of any such change.
   Moreover, some  members of our profession, both as students and as
 practitioners, become interested in the history of disease for itself alone,
 and  fail in a due regard to the final purpose for which  it is to  be studied.
 1 wish to  make  this statement clearly and carefully, because this branch
 of study is, in its proper proportion, the  only sure foundation  of a  good
 practice.   But there is danger of failing  to keep  constantly in mind its
 relation to practice ; of regarding it too much as  a mere  scientific  pur-
 suit.  This is a  fault into which  men of the highest  education are per-
 haps the most apt to fall.   They acquire the habit of studying disease
 merely as an object of science.  It  may, indeed, be worth studying as an
object of science merely.   But he  who would practise medicine, must
study it with a view to the practice of medicine. 
9
""Accurate diagnosis is of course essential  to the good practitioner, but
the student may take a  wrong direction  even in the study of diagnosis.
He may bestow undue  pains upon certain  parts of it, to the neglect of
others.   As a striking example of this, I  may refer  to the paramount in-
terest  which  young  men are apt to take in the  diagnosis of  cases cha-
racterized by a  few  marked  and salient features—especially in the mi-
nute diagnosis of diseases of  the heart and lungs by physical signs.   Let
me not be misunderstood.  I  fully appreciate the value of this species
of investigation.  But we often give to it a disproportioned attention,  and
attach  to it  an  undue  value.   We take great pains in determining mi-
nute points of diagnosis for the sake of detecting them, to  the neglect
of many circumstances in the  history of diseases, the knowledge of which
is of far more consequence in determining their management.
   This is  a  very  natural as well  as a very common error.   It is  one
which  has certain good  results.   It cultivates and disciplines the powers
of observation and discrimination.   This is  the kind  of observation to
which  the student should first devote  himself.  The  danger is, that he
will  attach to it an  undue importance ; that he will rest in it, instead
of advancing to other  modes of investigation.   The exactness, and,
scientifically   speaking,  the   beauty,   of its   results,  are  captivating.
There  is a certainty in  them which is gratifying to our pride ; but we
should recollect, that this is the most superficial and  the least  difficult of
our modes of inquiry into disease, and that it affords us but  a small part
of the information which is  necessary in order to enable us to treat it
successfully.
   Take, for example, the very common case of an organic disease of the
heart.   The minute  points of its diagnosis are  of great interest; they
may present  many nice  questions which require  the most careful scrutiny
to decide.  But suppose  them settled.   Suppose we  have  determined
which  cavity and which valves are  diseased ;  and how, and how much
they are diseased.   Does this establish the prognosis, or the  treatment ?
Not at all.   These depend upon entirely different considerations.   The
patient's age, the origin  of the disease, its length, its rate of progress, the
secondary  affections  in other parts  which it has produced, the mode in
which  the  system is  affected by it, are all  to  receive  the  practitioner's
attention.  I believe  I  am safe in saying,  that, in  a  case of this kind,
the treatment is more dependent'upon the manner in which other organs
are secondarily affected, than upon  the  condition of  that in which the
primary disease exists.  The  man who merely satisfies himself, in a gene-
ral way, that the heart is the  seat of disease, and then investigates  assi-
duously all  the other phenomena, will, in my opinion, give far better aid to 
9
the patient, than he whose almost exclusive attention is directed to the
nice determination  of the local  diagnosis.  The ship-master who is  a
careful observer of  the  winds and currents—of rocks and shoals—who
keeps a watchful eye upon  the  course of  his ship, and  trims his sails in
accordance  with favoring or adverse gales, though with but a rough ap-
proximation to his  latitude and  longitude, will make  a quicker and safer
voyage than the accomplished observer who  can determine his place on
the ocean to the fraction of a second, but neglects  the  other and weigh-
tier matters of seamanship.
   And here  it  occurs to me to mention  a distinction, not always suffi-
ciently adverted to, which yet lies at  the  very  foundation of good prac-
tice—the distinction between a pathological and  a therapeutical diagnosis
—the diagnosis which determines the technical character of the disease,
and that which determines the principles  upon  which it is to be treated.
In the preceding illustration the  pathological diagnosis  is  the determina-
tion  of the precise organic change in the  heart; the  therapeutical diag-
nosis is the determination of that condition of the system or of the other
organs, or of the habits, or of  the exposure of the  patient, upon  the
management of which depends  the cure, the suspension, or the relief of
the disease, or  merely the  mitigation of  his suffering.   This  condition
may be in the lungs, the liver,  the digestive organs,  the  kidneys, or in
the habits of life, or the locality or the  climate,  in  which  the patient
lives.  The therapeutical diagnosis is far the more important.  Cases of
which the  pathological character is  precisely the  same  may require a
treatment diametrically  opposite.   Some instances of  this kind are so
strongly marked, as to force themselves  upon the notice of the most ex-
clusive pathologist.  No physician would, for  example, treat the pneu-
monia which occurs in the  last stages  of chronic  disease, as he would
that which seizes a person  in health ;  nor the  pleurisy of a tubercular
patient, as he would  that  of a sound  man ; nor  the  apoplexy which
comes on as the result of a granulated kidney, as  he would that which
strikes down a robust, short-necked, plethoric individual in the vigor of
life.   These cases  speak for themselves.   But the same essential distinc-
tion runs  through  all  cases of disease ;  and it is the  perception and due
appreciation of this fact which  makes the chief difference between one
practitioner and another.
   Take for  a  further example typhoid  fever.   One physician, deeply
skilled in pathology, makes early a perfect diagnosis.   He rests satisfied
with this ; the great labor in the case is accomplished, and he treats it as
his teachers or as his books  direct; that  is to say, he bleeds or purges, or
gives. calomel  or antimonials or stimulants,  according  to  the school in
                  2 
10
which he has been brought up.  But another man, less expert in diagno-
sis, studies  less carefully the signs  which  distinguish  the  precise nature
of the malady, and may perhaps remain in some doubt as to the diagno-
sis, or he may even come to a wrong one ;  but he investigates more tho-
roughly, and understands  better, the varying conditions of the organs of
the system, on which the treatment depends.   Even  if he does not know
what the disease is, he knows what  course of management will best ena-
ble the patient to contend with it successfully, whatever it may be ; and
he reduces, evacuates,  quiets, stimulates, supports  or feeds the sick man
according to  the  particular  indications  afforded  by the individual case.
You will find such a man sometimes using remedies  in  this disease,  or
at some period of it, which would make the former shudder ; giving wine
or opium, for example, where the former would vomit or bleed—or, per-
haps, letting the patient alone,  and  leaving him entirely to the resources
of nature, in  a  state of things which to  the former  would seem to re-
quire  all the resources of art.
   We might multiply indefinitely examples  of this  essential  distinction.
In one case of apoplexy, to open a  vein may be to raise the subject from
death to life;  in another, pathologically just the  same, it is to  sign his
death warrant with  his own blood.  In  one case of delirium, an opiate
wraps the sufferer in a delicious slumber, from which he awakes refreshed,
his scattered senses restored  to  their  propriety; in another, it only serves
to fill  his mind with  images more horrid than before,  or to procure an un-
certain  and treacherous repose from which he  never awakes, or, at best,
awakes  in  a state  of  aggravated excitement.   In short, scarcely a case
presents itself in which we do not find occasion for the application of this
distinction.   To neglect it, to overlook it, is  to fail  in arming ourselves
with a species of knowledge which is essential to successful practice.
   It should farther be stated with  regard to this distinction, that,  whilst
the pathological distinctions  of  disease are very  many, the therapeutical
are comparatively few. Of this we have a very clear illustration in diseases
of the skin.   The variations  in their form, extent, and  aspect, in the
texture  affected and the mode of affection, are very many.   They are
capable of a minute and accurate classification and  description, and you
may make of them an almost  indefinite number of genera and species, all
sufficiently distinct from one another as objects of pathological observation.
But their  successful treatment does  not depend on an accurate discrimi-
nation of this sort alone, though such a discrimination may aid in it; it
depends more  upon the discovery  of certain  morbid  states  of the di-
gestive organs, of the secretions of the liver, the kidneys or the skin, or of
a diseased state  of the blood  itself, of  which the cutaneous eruption is 
II
merely one of the results.   These conditions  are few, and the same one
of them may exhibit itself in different individuals in the production of very
different appearances upon the surface.   Hence the same kind of eruption
may at  different times require very  different treatment; while eruptions
varying essentially in their pathological character may yield  to precisely
the same remedies.
   As one of the results of this  distinction, it often must have occurred
to  most practitioners to  observe, that  they can  treat many cases per-
fectly  well  although they  may  not have  been able to make out their
scientific  distinction; and, on the  other  hand,  that  they  are quite
at a loss sometimes where this  distinction is  perfectly clear.   Hence,
too, we find,  that  a  very   excellent pathologist sometimes,  nay,  I
am afraid, quite often, may make but  an indifferent practitioner; whilst
some men, with a very  moderate amount of pathological learning, but a
large fund of sound common sense and a natural talent for nice observation,
will make very excellent ones.   They seize, with an intuitive quickness of
perception, upon those conditions  of disease on which its  management
depends ; they learn, by an experience guided by their original sagacity,
how far diseases are controllable  by art, what conditions of them  are so,
and the agencies by which it can be done—and they apply this knowledge
with a wisdom which is sometimes altogether  beyond that which  merely
high attainments in science can confer.   I am disposed, in connection with
this topic, to introduce the words of one of the most eminent practitioners
of our own or  any time, which have a  certain  bearing upon the  subject
of which I am speaking.  "  I am convinced," says Dr. Baillie, " that
the most successful treatment of patients will depend upon the exertion of
sagacity or good common sense,  guided  by  a competent  professional
knowledge, and not  by following strictly the  rules laid down in books,
even by men of the greatest talent and experience."  " A physician who
should  be guided by the rules laid down in books would be a very bad
practitioner."
   It is a result of  the same course of remark  that an exclusive Hospital
Education is not favorable to the formation of the best practitioners.   In
the first place it leads the student to attach an undue importance to the
nicer pathological distinctions of disease as compared with its therapeutical
relations ; and in the next place  it  leads him to take an especial  interest
in  cases 'of a  strong and  decided  character,  which present prominent
features for observation  and analysis, to the neglect of those that are vague
as subjects of  diagnosis,  but yet call more than the others for the inter-
ference of  art.  Thus we see  students  crowd around  the hopeless bed-
side of the subject of an  internal  aneurism, or of organic disease of the 
12
heart, or of pulmonary consumption, where  some nice stethoscopic dis-
tinction is in controversy ; whilst they pass carelessly by patients laboring
under complicated disturbances of the functions, quite amenable to treat-
ment, but presenting no distinct  and tangible features to repay scientific
investigation.   Yet,  in actual  practice, it  is in  the management of these
latter cases that we can do the most  good—and it is these that we are
most frequently called upon to treat.
   A man's character as a practitioner is often injured by a special interest
in diseases of  a particular class, or in modes  of treatment of a particular
class.   He  may  have  a hobby both in pathology and  therapeutics,
which  he rides very much  at  his patient's expense.  Thus one man is
disposed to find everywhere disease of the stomach ;  another man disease
of the liver ; another, of the heart; and so on.  Some trace all diseases to
congestion ;  some, to irritation ; some, to spasm ; some, to inflammation ;
and some, to the state of the blood.  Having their pet diseases, they are
very likely to  have  also their  favorite  remedies ; and all their patients,
with little regard  to differences of condition, are put under very much the
same course of treatment.
   Let me repeat, that the point I have endeavored  to  illustrate is, that
the main purpose of all medical education is to make good  practitioners,
and that all other  considerations are to  be subordinate to this.   I feel
further bound,  in  connection with this subject, to  express a  doubt I have
often felt, whether that part of the  education  of young men which is
pursued  abroad,  has always  had a  favorable influence upon them  in
this  respect.   It  has seemed  to  me, that the same time, the same ex-
penditure, the same diligence at home, with the opportunities afforded them,
would train  them quite as well, if not better, as  practitioners.  I would
not undervalue the knowledge of the  history and  pathology of disease
which they acquire abroad, and the  time has been when these were not
to be acquired  at home ; but,  generally speaking, the acquisition  is not
made under good practical influences, and has not therefore  its best effect
in preparing for practice.   This  seems to me to  be partly owing to the
fact, that our  students chiefly resort to the  French schools.   No  nation
has contributed more, it is true, to the  progress of  medical science than
the French.  But their tendency  is to be satisfied  with the science.  The
French mind is not practical.   On the contrary, the English and Ameri-
can  is eminently so; and I cannot but regard it as  unfortunate  for
practical  medicine, that the  French schools  have been  so generally
resorted to  by our  countrymen  in  preference  to those upon the other
side of the channel.   It is not that  they will  find,  or  get, more  science
in England ; but  what they get, they will get in relation to its proper uses. 
13
   The English, like ourselves, as it has been said, are essentially a practi-
cal people.   The first question with them  in  all matters of science is,
What is the use?   We owe  as striking scientific results, perhaps, to the
French as to the English ; but who have originated the principal applica-
tions of science to the arts ?   The whole social  life  of man  has been
revolutionized in our day by these applications.  Space and time have been
almost annihilated.  We live and move and have  our being in almost a
new universe.   To whom are due the discoveries and inventions which
have  wrought  this great  change ?  The  French  have investigated che-
mistry, the laws of steam, hydraulics, mechanics, the whole of  natural
philosophy, quite as successfully as the English.  But who has applied
them to practical  life ?  To  whom do we owe the spinning-jenny, the
power-press,  the steam-engine,  steam-boats, gas-lights, railroads, locomo-
tives,  the  magnetic  telegraph,  the  lightning  rod,  ether,  chloroform ?
Either  to Englishmen or  to  their  descendants.   And as it  is in every-
thing else, so it  is in the application of the science of medicine  to the
art of medicine.   We can enumerate half a dozen English writers whose
works contain more lessons of practical wisdom  than the whole catalogue
of the French.   Where is  their Sydenham ? or their Hunter ? or, to come
down to our contemporaries,  I know not a single  work, which, for those
sound, common-sense, practical  lessons, that can alone fit a physician for
his ordinary  duties, is to  be compared for a moment with those of He-
berden, Prout,  Abercrombie, and Holland.
   In  saying  this, let  it not  be understood that I intend an unqualified
commendation of English  practice, for, although  now  greatly modified,
it has always partaken too much of  the  officious and perturbating ten-
dency.  But even in its faults you see the kind of influence it may have
in directing the  student's  steps into the right path.   It  is the constant
striving for use which has made it too active.   The advantage to the
student is, that he is always under an  influence  which leads him to con-
sider the  practical relations  of whatever he  learns.  The principle of
progress he acquires will be practical, and not speculative.  He may not
learn more;  but whatever  he learns will  be associated in his mind with
the strong impression, that the use he  can  make of it, gives to it its chief
value.
   Many other considerations might be urged as  reasons for preferring an
English medical education.  Some of these are sufficiently obvious, such
as the  identity  of language, the social relations, the greater resemblance
in the moral and religious  standard of society in  England to  our own ;
but that which I have mentioned is quite sufficient to induce  me to
advise  every  young man  to  study  at  least a  part of the time  he 
14
spends abroad, among  the  surgeons  and physicians of the land of his
ancestors.

   Among the points connected with professional preparation which are of
importance in promoting the success of the physician, is a careful study of
the laws of prognosis in disease, and a use of the knowledge thus acquired,
with that caution  which should be always used, where we are so liable to
uncertainty and error as in this department of our art.  A physician may
form  a  correct judgment of the character  of a disease, and understand
perfectly well the principles  of its treatment, and yet judge very imper-
fectly as to its course and result.  In other words, he may be deficient in
a knowledge  of prognosis.   This  knowledge  is of  value in two ways.
First, it is a guide as to the energy of treatment, even  where it may not be
as to  the  kind.   The necessity of remedial  measures depends much on
the amount of danger.   What and how much we do, will be determined
by what we foresee will happen if nothing  be  done.  If we can satisfy
ourselves  that a patient will recover spontaneously within  a reasonable
time,  we may justifiably abstain from the painful and disagreeable reme-
dies which might be required were his life or future health in danger.  In
the second place, a competent knowledge  of prognosis  is necessary in
order to  ensure a  fair  estimate  of our  qualifications  in  other respects.
Mankind  are  not good judges  of our knowledge  of pathology, or of
diagnosis, or even of treatment.   We may be wrong—and the world and
even  ourselves remain  in ignorance  of our mistake.   But it  is not so
with prognosis.  When  we say that a patient  will recover, and  he dies ;
or that he will die, and he recovers, everybody can see  that  we were
"wrong.   The same is  true of all the minor  points  of prognosis.  The
world is apt to judge of our knowledge  upon  subjects of which it is ig-
norant, by what it perceives  of our knowledge upon  those with  which it
is  acquainted.   Consequently  when we  are known  to make mistakes of
one kind, it  is naturally enough inferred that we are liable to those of
another.
   It is .right that the young man should avail himself of all honest
means to ensure a fair estimate of his qualifications.   He should certainly
■seek to appear to know  as much  as he really does know, and his  actual
attainments are often undervalued from a deficiency in some  of the minor
details of  practice, which are  mainly to  be  acquired by familiarity with
disease at the bed-side.  This deficiency  is  readily perceived  by the
habitues  of  the sick-room, and is often construed to his disadvantage.
Nurses, in particular, are apt to be watchful and jealous  of young men.
They are often the arbiters of  his fate—the  fatal sisters who may  cut, 
15
if they  do not  spin, the thread  on  which  his  destiny is  suspended.
They are  sometimes hard  judges.  Obliged as they are to submit to  the
unquestioned dictates of the old man—or at least to criticize them in se-
cret—they often make amends for this by watching with painful scru-
tiny the management of the young  one, hoping  for some flaw, which
may be made the means of  displaying  their superior knowledge and sa-
gacity.   A favorable impression  is made  by the exhibition in  the sick-
chamber of a familiar acquaintance with its little  details and the minor
operations and manipulations one is  called on to perform, to direct, or to
judge of.   You may make  great mistakes  in  practice with impunity ;
nobody may find it  out,  and you may not suspect it yourself.   But if
you bungle in bleeding, or break off  a  tooth in attempting  to draw it, or
fail in passing a catheter, or know nothing about the making of gruel  and
poultices, or the making  up of the obstetric bed, you may be set down
as an ignoramus, even although  you might be able to win  a professor's
chair at a medical concours.

   Very much of a  physician's success, especially  in early life, depends
upon his manners and deportment, more  particularly in his  intercourse
with  the  sick.   This everybody acknowledges.   The success of many
depends  wholly upon this.  They have no other recommendation.   We
meet with individuals who really acquire and retain more credit and con-
fidence from  the mismanagement of a case which terminates fatally, than
others will  gain  from the most  judicious treatment of one  that has  a
favorable result.
   Upon what does this depend ?  It  is at once  obvious to those who
have observed the matter, that they who exhibit a great difference in this
respect from each other are equally successful;  and that the  man who is
very popular with one set of patients is  often very unpopular  with  an-
other  set.  The  explanation of this  is sufficiently obvious.   Patients
themselves are of different temperaments.   Some are hopeful, and some
are desponding ; some are courageous, and some are timid ; some are diffi-
dent and require support from others, whilst some are self-dependent; some
are acute and penetrate the true character of those who attend them—
whilst others are superficial  themselves and do not look below the surface
for the character of others.   Some love flattery  and subserviency, whilst
others are disgusted by it.   Hence different  peculiarities of  manner are
with different people the passport to their regard, and persons of  entirely
opposite external  qualities may  be  found among  the  most acceptable
practitioners.
   One man  who  succeeds is a boaster.  He is a living  advertisement of 
16
his own recommendations.   His talk is of great cures, of which he tells
lono- and marvellous stories;  of the distinguished and well-known families
whose attendant he is;  of the great distance from which patients come to
seek his advice.  He loses no opportunity of impressing on  mankind his
great skill and his extensive reputation.  There  is  another who develops
his self-complacency in a different manner.  He  is  lofty and oracular.
His style of discourse is that  of a superior ;  he cherishes something of the
old mystery in  which the profession used to delight.  He talks obscurely;
he entrenches himself behind technicalities,  is magnificent upon trifles;
he even deals out his  pills with an air of majesty.  There is still  an-
other,  who  is  irritable  and arbitrary;  who  is a tyrant in the sick-room;
who resents every little disobedience as a personal  insult, and regards  the
natural expressions  of doubt and  anxiety as so  many reflections on  his
professional character.   As  his opposite, there is  one who is all gentle-
ness ;  who always assents—never finds  anything or  anybody  in  the
wrong ; who courts the  patient, the friends, and  the nurse—and has a
flattering word  for  each ; who is all things  to all; who is a sycophant
and almost a hypocrite—whose countenance is the index to his character;
                  " Eternal smiles his  emptiness betray,
                  As shallow streams run dimpling all the way."
Then  there is  on  the  one  hand  the  man  of invincible taciturnity, in
whom  silence is taken by  some as  the sign of wisdom ; and on the other,
the man of invincible  loquacity,  whose  never-ending stream  of words
flows on as innocent and as empty of meaning as the babbling of a sum-
mer brook.
   In this picture  there is perhaps  a little exaggeration of what we meet
in actual life ; yet  men  exhibiting these various peculiarities do  often-
times succeed.  Their currency, however,  is usually with a limited class;
those  who like one, naturally dislike his opposite.   But  there are some
physicians whose mode  of intercourse  with the sick,  recommends  them
equally to all, independently  of  any mere reliance  on  their medical skill.
Now upon what does this depend ?  I will  endeavor  briefly to  present a
sketch of the circumstances which contribute to this result.
  To most persons  a fit of sickness is an important  event; the  physician
is associated with all its recollections ;  and he will best secure the confi-
dence  and regard of the patient and  his friends who  has  most  distinctly
contributed to make those recollections agreeable ; who has succeeded best
in beguiling  its wearisomeness, diminishing  its discomforts,  relieving its
anxieties, dispelling its fears,  and raising its hopes.
  In order to this  a variety of circumstances demand  attention.  The
patient should feel  that you  take an interest in his case.  A  physician 
17
may take this interest  without  appearing to do so, or he may appear to
take it when  he does  not.  It is better for him that he should both take
it and manifest it.  A man who is thoroughly in earnest in his profession,
will make every case enough  of a study to understand it, and this will
be usually apparent;  but some men  always,  and all of  us  sometimes,
exhibit a species of carelessness and indifference which even if only appa-
rent has  an unfavorable impression on the mind of the sick man.
   Many cases of disease which seem to the patient very  important,  the
physician at  a glance sees to be quite otherwise.  But the apprehensions
of  the patient will  not be relieved unless he sees that you have given a
sufficient consideration to his case to enable you to  form a careful judg-
ment of  it.   He has a  right to your deliberate opinion.   If he has thought
his malady a grave one, he is not  likely to be  satisfied with your view of
it unless he perceive that you have given a candid consideration to his.
   The patient,  then, should always be allowed a fair hearing.   It is gra-
tifying to him to have his account fully heard  and well considered.  To
many invalids there is an absolute pleasure in  detailing their experiences
to  one  whom they believe capable of forming a judgment  concerning
them,  independently of any expectation  of relief;  so that, among  the
qualities which tend to make  a physician  acceptable,  is that of being a
good listener.   I do not mean to say that  you are bound to listen to all
that a garrulous and tedious invalid may choose to inflict upon you ;  but
it  is for  your interest  to be rather indulgent to this propensity, and you
are bound to let the  patient,  as far as practicable, tell  his own story in
his own  way, and  not abruptly to cut him short  in the narration of  de-
tails, which appear  important  to him, and of which you cannot yourself
fairly judge till you have heard them.
   One should allow a certain degree of weight to a patient's view of his
own case, and  to the  opinions of those who are constantly around him.
Not that  we are ever to give up our  own careful judgment for theirs ;
but we are to consider theirs in making up our own—especially as regards
prognosis.  This remark  particularly applies  to acute cases, and  above
all   to acute  cases in children.   We are not hastily to put aside the  im-
pressions of those who are constantly around the sick-bed, and who have
therefore an  opportunity for  observing many things which  we do not.
These impressions  are very often erroneous, tinctured with prejudice and
exaggerated  by apprehension ; still let them be attended to.   Every man
must, I think, recollect cases, where the judgment of others,  especially
concerning the  severity  and the result of  a case, has turned  out to be
better than his own.
  The conversation of the sick-room  is a  matter of some consequence,
                 3 
18
and  the regulation of it  with  delicacy  and tact constitutes one of the
recommendations of a physician.  lie is indeed first  to decide  whether
any at all is to be allowed ; as, in many cases, it is altogether inadmissi-
ble.   But  at  some  period  in  most acute, and generally  in chronic dis-
eases, it  is not only admissible, but, if duly regulated, may do something
to beguile the tedious hours of  confinement.   The  visit of the physician
is an important event in the day of the invalid ; and although the state of
his case and the direction of his course are the chief things to be regard-
ed, yet it is not to be forgotten that  much may often be learned of his
condition  by  observing  him  when  his  mind is  withdrawn from the
contemplation of his symptoms, and that the  agreeable  exercise of his
faculties  and  the  diversion  of his attention may  do something in aid
of strictly medical management.
   It is not always easy  to  manage this  in the  best way for each  indi-
vidual.   The general tendency of invalids is to dwell upon and talk over
their complaints,  to observe their symptoms with great attention, and  to
detail them very minutely.  So far as this will throw light on their dis-
eases, it is right to indulge  them; but when  it proceeds  from a morbid
habit  of mind, and is  found to vitiate the imagination and to  lead the
patient to exaggerated views of his disease, it is injurious.   The physi-
cian should not unceremoniously interrupt such discourse ;  he should give
it all useful attention ; but for the sake of the healthml state of  the  pa-
tient's mind, as well as for his  own comfort, he should lead the thoughts
away to other subjects.
   The conversation of some physicians in the sick-chamber is frequently
regulated, by a regard more to  their own interest, than to that of the sick
man.   They indulge  in narrations of their medical experience, and espe-
cially in accounts of cases similar to that of the person on whom  they are
attending.  This is apt to  be done from a desire of self-glorification ; it is the
ebullition of self-complacency;  its  object  is to produce a favorable im-
pression of the importance and  qualifications of the speaker.   It is lauda-
ble only when it  is intended to soothe the anxiety and encourage the
hopes of  the  patient ; and this may sometimes be done  by an  account
of cases similar to his which have had a favorable result.
   It is almost  unnecessary  to  speak  of the value of kindness and cor-
diality  of manner; and  simple kindness of manner is, I am happy to
say, one  of the most common characteristics  of the  profession.   Few
that have been much  engaged in practice, are  deficient  in  it.   It is a
habit almost necessarily forced upon them by their  daily business.   But
it is not inconsistent with a very superficial character in  all  essential re- ~
spects, and .may be combined with much selfishness and  an  actual disre- 
19
gard of the patient's welfare.  Still it  goes far, even  if it  be wholly
external ;  but much farther, when  it is  the true expression of kind feel-
ing, and  is the shining forth of a generous sentiment from within.   One
of the important results  of this genuine quality is  a due consideration
for, and patience with, the weakness and infirmities  of sickness.  These
are sore  evils, and  they are  no  small  trials to even  well-disciplined
minds.  Continued  suffering, protracted confinement, disappointed ex-
pectations of recovery, all tend to  produce impatience, irritability, and a
selfish  regard to mere personal  considerations.   The influence of this
state of mind may extend to  the  friends of  the  sick man, who partake,
in a measure,  of his sufferings and  trials.  The result is sometimes such
as to prove  no small tax upon our patience  and equanimity.   It is par-
ticularly so in  our younger days, when our authority is less, and the habit
of unquestioning confidence in us has not  been formed. There are certain
degrees of it,  and  certain  modes of its exhibition, which cannot be sub-
mitted to consistently with a proper self-respect.  Still much of this is to
be borne; it is not to be seen.  On the  other hand, there is often cap-
tiousness and irritability in the physician, which are far less excusable
in him than in the patient.  We  are not childishly to take offence at lit-
tle expressions that  annoy us—at hasty  or angry words—at suggestions
as to variations in our treatment—at every little deviation from the exact
path we mark out, or even at  the interference of ill-judging friends, or at
the desire to have other advice than our  own.   We  are  apt to construe
such things as intended to mean more than they do—as  implying doubts
of our skill, our knowledge, our  judgment.   They are  generally not so
meant; and if so regarded, may often make us feel  offended with those
who have a proper reliance on our judgment, and entertain  the kindest
feelings towards us.
  In our  younger days, a readiness to admit, and even  to seek, the ad-
vice of older men, rather contributes to success, unless  it  be the result
of timidity—of nervous  and unfounded  apprehension—or of ignorance.
1 have often  heard it mentioned as  a recommendation to a young man,
and as a  reason for giving him patronage, that in  all important cases, as
soon as he perceived the approach of danger, he was  ready to call  in the
aid of his more experienced brethren.  This  removes one of the sources
of hesitation about  the  employment  of  an untried practitioner, and im-
parts a feeling of safety to those who do employ him.   Indeed there is
no way in which a patient is so likely to  derive  all possible aid from our
art, in a case  involving great anxiety and danger, as  when  he is  under
the combined care  of an  old and a young physician, and  has all the
NATIONAL  LIBRARY OF MEWChNE
      WASHINGTON, D. C. 
20
advantage of the observation and vigilance of the one, and of the expe-
rience and wisdom of the other.
   Cheerfulness in the sick-room is  an important item among the quali-
ties  of an  acceptable  practitioner.   His  deportment  in this particular,
must, of course, depend, in  some measure, upon the gravity of the case,
and  the  amount of anxiety on the part  of friends.   He should never
be frivolous or trifling.   His occupation is a serious and  sober one, and
it becomes him to  be  and to appear a  serious  and sober  man.   But
this  is not  inconsistent  with  a uniform cheerfulness.  It is revolting to
the feelings of the  sick man and his friends to see you  light and indif-
ferent, when they are tortured with  apprehension ; but to see you cheer-
ful imparts  to them confidence  and  serenity.   To  some, cheerfulness
belongs by  temperament ; but  others, who are naturally disposed to
look upon the dark side of things, find it  difficult to acquire it.   Indeed,
with the heavy and often painful load of responsibility which is resting
upon us, it is not always easy, even  to  those of a buoyant nature, to re-
tain  the  necessary command over  the feelings.  The impression, made
by the sad  aspect of the chamber  where friends are weeping  about the
bed  of departing life, may not have been entirely dispelled before we en-
ter that  where they are  rejoicing around the cradle of a new object of
love.  The gloom of one sick-room may  follow us into another, and in-
fect  that also by its  contagious influence.   The patient may read an un-
favorable augury as to  his condition, in  the countenance and manners,
which have derived their character from scenes we have just left.
   The best help to the acquisition of the demeanor of which  I speak,
is the cultivation of habitually cheerful  views of life and  providence.
No man is  more called  into close  communion  with his fellow beings in
their dark and trying hours, than the physician ; and no man, therefore,
needs more  than he, both for his  own  sake and  for that of others, to
be able to look upon the brightest lights of the darkest picture.  It is one
thing to  be indifferent, when  those with whom we have intercourse are
laboring under painful apprehensions, or suffering  heavy afflictions; it is
quite another  thing to  be  seriously cheerful.   This is  not  inconsistent
with the deepest sympathy.

   The physician should seek to understand those things in the manage-
ment of the sick which especially contribute to their  comfort.   It is not
enough to carry your patient safely through his  disease—you should aim
also to carry him comfortably through it.   It is even not too  much to
say, that ensuring the comfort of a fit of illness, does no little  towards 
21
making it safe.  In  a majority  of cases, I  believe that  the discomforts,
the annoyances, the  sufferings, which attend disease, are looked back
upon with quite as much horror as its  dangers.   Many, who are not  dis-
turbed at the  prospect of death, shudder when they look  forward to the
endurance of pain.   Many, who are tranquil and happy when their lives
are in imminent hazard, are made  irritable, peevish and wretched by
the little annoyances of a malady which is perfectly safe.  A patient is
seldom certain that his physician has saved his life ;  but  he often knows
that he  has  been made comfortable  by his  words  or his prescriptions.
The adroit and timely administration of remedies which relieve pain, or pro-
cure repose, or allay some of the thousand disquieting symptoms of disease,
though they may form no  part  of the essential  course of its treatment'
make  a more vivid impression than the wisest therapeutic management
in other respects.   The cataplasm which has quieted an aching side, the
draught  which has  soothed the  irritated nerves, the opiate which has
given  to the jaded  sufferer a  night  of placid  slumber or of delicious
visions, leave far more agreeable  associations  than  the harsher remedies
which are employed to encounter the  more formidable events of disease.
   The physician who is rich in expedients for meeting the ever-varying
phenomena of disease, whether of mind  or body, will always  be an ac-
ceptable visiter at the bed-side  of the  sick.   Perhaps some may regard
the importance I attach to details  of this  sort as a little exaggerated.
Let me say,  as the  result  of some observation of this  matter, that, so
far as the success of the practitioner is concerned, he who  studies to
make  the  sick-room  agreeable  and comfortable, is more  certain  of it,
than  he who studies only to make it safe.  Now as the two are not in-
compatible—but, on  the contrary, since  making it  agreeable and com-
fortable, makes it also, to a certain extent, safer, it is surely the part of
policy, to say nothing of humanity, to practise all those  arts that tend to
produce such  a result.
   Self-reliance, in which is included self-possession, is another important
element of success.   In all affairs we  are instinctively  led to rely upon
those who rely upon themselves.  We know how much this quality, even
when  carried  to the extent of arrogance and self-conceit, will accom-
plish  in  ensuring  a certain kind of success.   But self-reliance mav be
modest, unassuming, and without  presumption.  Where so many things,
both  as  to the nature of disease and  its best treatment, are necessarily
uncertain, the mind of the physician  must often be in a  state of hesita-
tion  and  doubt.   But  neither  the patient nor those interested in him
should be  suffered to partake  in the anxiety  which this circumstance 
22
 occasions.  This burden  it is  a part of our business to bear  for them.
 When we have come to the best judgment, as to the nature and treat-
 ment  of a case, that  our knowledge enables us to form, we should,  as
 in all the other affairs of life, act according to it with  decision.   Because
 all doubt may not have been  removed, we are not to hesitate, or vacil-
 late,  or change, unless  new light should open to  us new views.   I
 do not mean by this that we are always  to rely on  the  decisions of our
 own minds alone.  Indeed, men who are deficient in judgment are more
 apt to be  jealous of the advice  and  interference of others, than those
 who possess it.   He who has  an honest and well-founded  reliance upon
 his own judgment, is perhaps the most ready man in the  world to wel-
 come aid and council from every quarter in the formation of his opinions.

   The relation  which the  physician bears to the other sex is peculiar,
 and  the mode in which  he regards this  relation and his consequent de-
 portment, make  another  topic  connected with the subject I am  endea-
 voring to illustrate.   His  daily duties associate  him constantly with wo-
 men.   They are more frequently his patients than men ; and, as mothers,
 as wives, as sisters,  as nurses,  they  are the natural  attendants in  the
 chambers of the sick.   Without  female  ministration they are dreary and
 cheerless indeed.   It is, then, not only his duty as a man, to  exhibit that
 deference and delicacy in his deportment which is their right—but it  is
 eminently for his interest to do  so, as a candidate for professional em-
 ployment.   The first -success of a young  man depends  especially upon
 his acceptance with  them.  They may be  his best  friends, or his worst
 enemies.
   In our intercourse with them as patients, many occasions arise in which
 there is great embarrassment to a  diffident and delicate female.   It can-
 not be otherwise.  It ought not to be otherwise.   Her  feelings  are, in
 the best sense, natural and appropriate.  In such cases it  will depend  en-
 tirely upon the tact and  delicacy of the  physician whether  violence  is
 done to these feelings, or whether they are soothed ; whether the informa-
 tion necessary to be had,  remains locked up in the bosom of  the patient,
or whether it is  kindly and gently drawn  from her without a wound to
her sensibility.   It makes an immense  difference to her, whether the man
 she consults regard the whole matter with  a hard and vulgar indifference,
and as one which is  to call  out no peculiar sentiment—or  whether he
duly appreciate the agitated  and often agonized condition in which she  is
placed.   It is certain  that  many females  suffer for  years  from causes
which might be easily  removed, for want of courage to  speak of them 
23
 to their medical  attendant—or for  want of that tact on his part which
 would  enable him  to elicit  an account they cannot bring themselves
 spontaneously to give.
   I beg leave, then, to impress it  on you, as  a most  important lesson,
 never to forget to maintain that deportment towards every individual of
 the other sex, which, being an  essential characteristic of the gentleman,
 ought, of course,  to be eminently  of the physician—never to approach
 any woman as a patient and  forget that  the relation you  bear to her is
 one peculiar to our profession, and  that  she may be called upon to con-
 fide in  you as she would in  no other human  being.   No doubt  there
 are  coarse  and vulgar women,  both among the high and the low, who
 are not offended or repulsed by a want of the deportment I mean, and
 to them coarse and vulgar physicians are not unacceptable.  But  even
 such are not insensible to the influence of a refined  and delicate  treat-
 ment ;  they appreciate instinctively the  homage which is  thus  paid  to
 their sex ; whilst  from the truly modest and cultivated it wins, more per-
 haps than any other quality, their confidence and regard.
   There is unfortunately something in  the  first influences of our train-
 ing which tends to impair the delicacy of our minds with regard to cer-
 tain subjects.   From  being matters of  constant  attention  in our earlier
 years, they become so familiar,  that  they cease to have  the  same asso-
 ciations to us,  as  they have to  others.   We consequently may  acquire
 habits of feeling, and  often of speaking, in  relation to some  topics  held
 in a certain reserve by mankind in general, which habits  are repulsive
 and even shocking to the feelings of others.   I may refer, as an example,
 not merely to the  subject upon  which I have  just spoken, but also to
 that of  dissections.  Certainly the  tendency of the habit of dissection is
 to produce a difference between  us and other men in the  feelings with
 which we regard the  remains  of the dead.  Naturally we  entertain a
 sort of reverence for  the inanimate  body of a  fellow being ; a kind of
 awe comes over  us  in  contemplating it ;  we  provide in  the most re-
 spectful  and  affectionate manner,  and  often at  great expense, for its
 sepulture ; we accompany it with  holy  rites ;  we are shocked if  even
 the remains of a stranger, or a criminal,.are committed to the grave with-
 out them.  Thus all our associations are of a tender and almost sacred
 nature.   But  the habitual dissection  of the  dead body, necessary as it
 is, surely has  a tendency  to  destroy these  associations ;  we may forget
that the  object before us is anything but  a  mere subject of our  art; it
may become to us no more than the inorganic materials of the chemist's
retort are to him.  Thence may arise an  indifference and even a levity of 
21
speech and manner, which are abhorrent to the sensibilities of the rest of
mankind.
   Now it is  not necessary that  this should be.   The influence exerted
is  so  gradual, the  change in  our habits  and feelings  is so insensibly
brought about, that we are not aware that it  has taken place,  and are,
perhaps, surprised  and offended  if it be  pointed out  to us.   But  the
testimony of others to its  reality  should  teach us carefully to look to the
influences to which we are exposed, on  this  and other  subjects,  in  our
habitual  pursuits.   It should  teach us to resist  whatever may tend, in
any degree, to diminish the tenderness, the delicacy, the purity  of mind,
which are so peculiarly required in the performance of our duties.
   These  considerations suggest, and they afford  an occasion for, a  few
remarks upon the position which  becomes us  towards those of the other
sex who are  candidates for practice in our profession.   It is well known
that it is now seriously proposed, not only to introduce them more fully
into that branch, which has always remained more or less in their hands,
but also  to prepare them,  by  a complete  medical education, to engage
in the general practice of the art.
   I trust we should be among the last to oppose the entrance of woman
into any department  of active  life,  in which she  can  secure to  herself
a  useful  and  honorable position,  and  a  full reward  for  her talents  and
services.   None know so  well, as those  of our profession, how heavy a
share of the burdens, the trials, the responsibilities of life  fall to her lot,
or wonder more at that mysterious arrangement by which the  author of
our being has assigned so unequal a destiny to  the fairest and most ten-
der of his creatures.   But so we know  it to be, and we should be the
first to promote her introduction to any occupation which will afford her
a fair portion of the pleasures, duties,  rewards  and honors of society,
aye, to welcome her to  our own, if it  can prove for her advantage or
 happiness.
    But whatever may be thought of her adaptation to the one  particular
 department  to which I have alluded—and for this I am willing to admit
that considerations of some weight may be urged—I cannot  withhold my
 conviction that the general practice of medicine would be found  unsuit-
 ed to  her physical, intellectual,  and moral constitution—that she could
 not go thoroughly through with  the preparation  necesssary for  it without
 impairing many of those higher  characteristics for which we honor and
 love her.   There  may be exceptions, but a  profession  cannot  be  filled
 by exceptions.  I  have spoken of some of the unfavorable  influences of
 professional pursuits  on our own minds; such influences would  be doubly 
25
hurtful in their results upon the mind of woman.   It  is  difficult to con-
ceive that she should go  through all thai we have to  encounter in  the
various  departments  of  the  study  of medicine, without tarnishing that
delicate surface of the female mind, which can hardly be imagined even to
reflect what is gross without somewhat of defilement.
   The  common Creator of man and woman, with a view to their rela-
tive uses in  the great economy of human existence, has seen fit to give
them constitutions widely different.  While to man he has given  strength,
to woman he has given beauty ; while  man  has  been  endowed  with a
capacity for the investigation of truth  by the laborious process of reason-
ing, woman has  been enabled to arrive at results, perhaps as  little  liable
to  error, by a mere act of  perception ; what he does by labor, she does
by intuition ;  he is  carried forward  in the active business of life by a
courage and enterprise which lead him to encounter and almost to court
dangers and obstacles ; she, whilst she  shrinks  at perils and  difficulties
when they are distant, meets them, when they assail her, with a fortitude
which amounts almost to heroism.
   The office of the physician and surgeon  calls for those qualities which
are  characteristic of man.   It  is attended  by many  hardships of body
and trials of mind, which,  though not greater than those which women
undergo, are yet different from them.  He must be exposed by night and
by day, to the wind and  the storm, to cold  and to heat; he needs bodily
strength, endurance, and activity.  So, too, he must be unmoved by suf-
fering ; he must be firm amidst dangers ;  he must have presence of mind
in doubt and difficulty ; he must not shrink from inflicting pain ; he must
forget that he is  doing so; he must not be carried away by his  strong
sympathies, he must often act as though  he  had them not.   Is the nature
of woman competent to this ?  Should  we love  her as  well if  it were ?
Would she not be less a  woman ?   We have each our office at  the bed-
side of the sick—but it is a different one.   We cannot perform hers, and
she cannot perform ours.
   But, however strong our conviction may  be, that the burden which we
often find it so  heavy to bear—the responsibilities which we sometimes
shudder  to assume—the toils which  are found to wear out the frames
and  shorten the lives  of medical men—are unsuited to the more tender
constitution of the other sex, let this  conviction be never expressed but
in the earnest and respectful language which becomes the subject. Let us
be sure that we are governed by a sincere regard for truth and usefulness,
and not by a mean jealousy of encroachment on a profitable field of  la-
bor.   We may be wrong in  our  views ; but, if right, the right will be
best asserted by that calm and unimpassioned expression of it which be-
                 4 
26
 comes at once the truth and our relation to the other sex.   Above all
 things, let opposition never  assume the  attitude of hostility or defiance.
 This  is no subject for ridicule;  and no man of honor or right feeling can
 ever make the respectable  female practitioner  the object of a heartless
 jest or a cold-blooded sarcasm.

   I have left myself barely time to hint  at one other element of the best
 success in our profession—an element  without  which, the others I have
 mentioned are but as sounding brass  and a tinkling  cymbal—I mean a
 high personal character.   To deserve and  retain the permanent confi-
 dence of mankind, the physician should be a man of honor, of integrity,
 of truth.   " No man," says Quinctilian,  " can be an orator, unless he be
 a good man."   How much more strikingly is this maxim true of the phy-
 sician ?  Upon whom are laid higher responsibilities ?  Upon whom is it
 more essential that  mankind should be  able to lean, with that perfect
 trust which can only be founded upon  moral qualities ?  And is it out of
 place to add here, that, as the crowning element in the medical character,
 there should exist a firm, but unostentatious faith, the only sure foundation
 for all other excellence.
   I cannot impress this sentiment more strongly than by using the words
 of a late teacher in this school, eminent  for his long services in the pro-
 fession, and for the many  benefits he has  conferred upon this institution.
 "A mere moral sentiment is not a sufficient support to the character of a
 professor of the healing art.   He is daily  placed  in situations  and involv-
 ed in responsibilities  which can be  known to no human  mind but his
 own;  and if he does not feel answerable for his conduct to a higher con-
 sciousness  than that of his  own  heart, he may stand on  ground  which
 will sink beneath his feet.   Religious opinions and religious feelings form
 a highly important part of the medical character.   They carry us through
 scenes of difficulty and  danger, in a manner satisfactory to our own con-
 sciousness.  They enable us to give support  and consolation to patients
 who are suffering under mental  as well as bodily distress; and they pu-
 rify all our conduct by the reflection,  that we must  give  an account of
 the motives of our acts, as well  as of  our manner of performing  them.
 The loss of our patient's  confidence,   the jealousies of our professional
 brethren,  the  disappointment of our sanguine hopes, are  all  soothed  or
 obliterated by higher feelings.   And,  finally, the confidence  of  every
patient, whether religious  or not, will  be greatest  in a physician who is
animated  by the noblest principles which  the human mind is capable of
entertaining." *

      • Dr. Warren's Address before the American Medical Association at Cincinnati. 
27
    And here I might close, but some may perhaps feel that it is discourag-
 ing to aim at  so high a standard, when  there are  so many examples of
 great  success in those who fall  far, very far below it—who  possess, in-
 deed, few of those qualifications  upon which  I have insisted.   It is
 mortifying to be obliged to admit that this is too often true;  that men do
 succeed  who are greatly deficient in the sterling qualities, which should
 alone give a passport  to  the confidence of mankind.  But I must  still
 maintain  that these are exceptions, and that, although in a few cases, they
 acquire a high reputation and  maintain it  to the end of their career, yet
 that usually it is not so.  More frequently their success is not permanent.
 They pass very currently during the early and perhaps the middle period
 of life—but its decline is attended by a marked diminution of reputation,
 and their old age is passed  in neglect  and forget^ilness.  Any one who
 has been conversant  with  the  profession  for a whole  generation, must
 have noted repeated instances, where men who have had  great notoriety
 and extensive  employment for a series of years, have declined in public
 esteem, and passed into comparative  obscurity,  at a period of life when
 those, whose characters  have been founded on the true basis, are reaping
 their richest harvest.
   But the success, even for a time, of men without attainments and with-
 out character, is by no means a slight evil; and it is a greater evil to the
 community than to  the profession.   It  has  been to me,  1 confess, a con-
 stant subject of amazement to witness what  small pains so many take to
 satisfy themselves of the real scientific and personal qualifications of those
 to whom  they entrust  so important a responsibility as that of their medi-
 cal  attendant.    We constantly see persons of  education, refinement and
 intelligence,  placing themselves,  their  wives  and their children, in  the
 hands  of  men not only ignorant of the  art they profess, but  whose very
 touch is contamination, and the atmosphere around them  corrupt.   While
 they spare no pains  and  grudge no expense  to secure lawyers, teachers,
 mechanics, who have had a competent preparation in their  respective  de-
 partments, they trust men as physicians of whom they know nothing but
 their vain pretensions, and of whom, very likely,  the worst feature is not
 their deficiency of medical education.
   Still, let me  not be  supposed to imply  that  this is generally true of
 mankind.   It is true of many—and  many of  whom we should not ex-
 pect it.   But there  is much in the nature of disease and in the effects it
 produces  on the mind, which account  for it.   You may be assured that
in the long run,  only men possessed of some  sterling qualities will secure
the permanent  confidence of mankind.   The examples to  which I have
alluded are prominent;  they excite our  attention—too often they pro- 
28
voke us to anger—but, after all, they are exceptions.   Tin; great mass of
medical patronage is enjoyed  by those whose education and characters
render them worthy of it.   Look around us in our own community, and
upon whom does  its affection and confidence most securely rest  for a se-
ries of years ?   Who among the  physicians of this place, within the me-
mory of the present  generation, have been most implicitly trusted and
beloved ?   They  have been  men of education,  of talent, of honor,  of
integrity, of benevolence.   We are apt to indulge at certain moments  in
complaints of ingratitude and a want of due appreciation ;  but I must be
permitted to say,  as the result of the experience  of many years spent  in
the most laborious duties of the  profession, in all classes, amon^ the rich
and the poor, the educated and the uneducated, the refined and the vulvar
the good and the  bad-^-that this complaint is unfounded. And let me say
too, as a word of  encouragement  to those  who are now takino- their first
lessons in our art, that  as I believe no man exercises a more honorable
office among his fellow-beings than  the accomplished  and conscientious
physician, so I believe there is none who reaps  a richer reward in the
confidence,  the affection and  the gratitude of those whom he is called
upon to serve. 
 
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