VALEDICTORY ADDRESS »®. «^2ft^ GRADUATING CLASS JEFFERSON MEDICAL COLLEGE FORTY-FIFTH ANNUAL COMMENCEMENT. DELIVERED JN THE / V ACADEMY OF MUSIC, / MARCH l'i, 1870. BY J. AITKEN MEIGS, M.D., ** PROFESSOR OF THE INSTITUTES OF MEDICINE, ONE OF THE PHYSICIANS TO THE PENNSYLVANIA HOSPITAL, ETC. ETC < ii IP PHILADELPHIA: COLLINS, PRINTER, 7 05 JAYNE STREET 1870. VALEDICTORY ADDRESS GRADUATING CLASS JEFFERSON MEDICAL COLLEGE, FORTY-FIFTH ANNUAL COMMENCEMENT. DELIVERED IN THE ACADEMY OF MUSIC, MARCH 12, 181"O. BY J. AITKEN MEIGS, M. D., PROFESSOR OF THE INSTITUTES OF MEDICINE, ONE OF THE PHYSICIANS TO THE PENNSYLVANIA HOSPITAL, ETC. ETC. 'JLoyC\: PHILADELPHIA: COLLINS, PRINTER, 705 JAYNE STREET. 1870. " The profession of the healing art, divine in its origin, grave and grand in its scientific evolution, sacred and sublime in its ultimate functions, stands as a necessary part of the order of things, old as humanity, and inseparable from its existence upon earth ; for when did not man suffer, and when did not his brother try to relieve him? " As the creation of the human body is the first significant fact of its history, its protection and preservation from the agencies of change and destruction about it must certainly be the second consideration of importance, scarcely less in its grandeur, surely equally solemn in its end. The soul incar- nated once, demands immortality as a right of its own being, and would ask it, also, for the body. What art so grand, then, as the art of preserving and prolonging life; and what so God- like in aspiration as the effort to restore man to the splendor of his unfallen youth, and save him from the tortures of pain and suffering, of disease and death?"—Dr. R. M. S. Jackson. CORRESPONDENCE. Jefferson Medical College, March 9th, 1870. At a meeting held by the Graduating Class of the Jefferson Medical College, it was unanimously Resolved, That a committee be appointed by the President of the meeting to wait upon Professor Meigs, to tender to him the compliments of the class, and request a copy of his Valedictory Address for publication. T. DAVIS DAVIS, President. L. L. Leggett, Secretary. Professor Meigs— Dear Sir : It is with pleasure that we, the undersigned committee appointed to wait upon you, respectfully solicit, in the name of the Graduating Class, a copy of your Vale- dictory for publication. Samuel Johnston, Maryland. Joseph Y. Porter, Florida. T. M. Attaway, Texas. F. E. Beckwith, Connecticut. Geo. A. Hill, Alabama. C. S Poley, Pennsylvania. C. E Black, New Brunswick. John W. Vinson, Georgia. J. A. Crook, Tennessee. Z. T. Dellenbaugh, Ohio. Geo. A. White, California. James Powell, Kentucky. W. H. Parish, Mississippi. J. R. Mitchell, Virginia. Hamilton Osgood, Massachusetts. Pedro F. Oxamendi, Cuba. Miguel Theyi.no, Mexico. E. W. W. Marsh, Delaware. J. E Spencer, New Jersey. J. M. Gates, Minnesota. Posey Collings, Indiana. E. Cullen Buayton, New York, J. B. Taxis, Illinois. A. F. Belo, North Carolina. W. 0. M. Irby, South Carolina. E. W. Clark, Vermont. Lemuel Watson, Missouri. S. H. Parker. Arkansas. J. M. Betts, Idaho. Jefferson Medical College, March 10th, 1870. Gentlemen : In compliance with your request, I place at your disposal the manuscript of my Valedictory Address. It was written for your benefit, and to you, therefore, it belongs. Accept for yourselves and the members of the Class my heartiest wishes for your future prosperity and happiness. That you may all become not only useful members of society, but shining examples, also, in the noble profession which you have chosen as the occu- pation of your lives, is the earnest prayer of your friend and well-wisher, JAS. AITKEN MEIGS. To Messrs. Samuel Johnston, Joseph Y. Porter, and others. YALEDICTORY ADDRESS. Gentlemen—Graduates in Medicine : Only a few years ago, having finished your collegiate or general education, you emerged from the quietude of the school-house to take your part in that bustling work of the world, which is ever being done, yet is never completed. And as you gazed irresolutely yet hopefully upon the busy throng around you, in which great actions and mean, good deeds and bad, lofty aspirations and grovel- ling desires so strangely blend, you began, for the first time, per- haps, in your young lives, seriously to reflect upon that momentous question which obtrudes itself upon most men at the outset of their career, and will not be denied an answer: What shall I do that I may obtain the wherewithal by which to live ? Such the question which gradually assumed a weighty aspect as you pondered ever the more thoughtfully and anxiously upon it. But as you deliberated, the inquiry took a philanthropic form; and so you queried: How may I earn my daily bread, and in so doing accomplish the greatest good for my fellow men ? Not in divinity, not in law, nor in com- merce, nor yet in the various handicrafts to which men devote their lives and energies, could you find the desired solution. Your mental peculiarities led you to see in the Healing Art alone, a satis- factory answer. So resolving that this ancient and honorable Art should become to you a life-long task, you abandoned the comforts and pleasures of home, and straightway repaired to this city, willing and solicitous to bestow labor, and money, and time, and to undergo much self-denial in the accomplishment of your resolution. You presented yourselves to the Faculty of Jefferson Medi- cal College—to my colleagues and to me—and entered with us into a solemn compact. You stipulated to be constant in your attendance upon medical lectures, and to consult your books dili- gently by day and by night. You promised, also, to be busy 6 among the dead in the dissecting-room, among the bedridden sick of our hospitals, and amidst the lame, the halt, the blind, and vari- ously ailing, that crowd in their misery to our clinics and infirma- ries. This covenant you have faithfully kept. Day after day the early sun looked down upon you at your posts; night after night the sleepless stars still saw you wrestling with your tasks like Jacob, in the olden time, with the Evangel of the Lord. You furthermore agreed to subject yourselves finally to a rigid examination, that your attainments in medicine and your qualifications to practise the ars medendi might be thoroughly tested. Through this ordeal, no light one, as you well know, you have satisfactorily passed, and in testimony thereof, the diploma of the college, stamped with the broad seal of its corporate authority, has just been granted to you by the Honorable Board of Trustees, through the hands of their learned president. And now, full of hope and energy, but with powers as yet un- tried ; like mettled chargers champing the bit, and fretting under the tightened rein, you stand, on this commencement day, ready and eager to hurry forth upon that toilsome, careworn, and sorrow- stricken road which men call a medical life. At the request of my colleagues I must now perform the last official act which severs the pleasant tie that so long has bound us together as teachers and pupils. I stand here not merely to con- gratulate you in this gracious presence, upon the brilliant termi- nation of your laborious novitiate, but to bid you an earnest, a heart-felt "God-speed," and, in obedience to a time-honored custom, to pour into your ears some words of advice, of warning and en- couragement, ere you go forth upon your mission of love and hu- manity, and in the dim, uncertain shadows of the future, are lost, it may be, forever from our sight. It is my purpose to speak to you of the manner in which you should conduct yourselves in the new sphere of action to which you have this day been promoted; to point out the duties which you owe to yourselves, your patients, and your medical brethren; and to indicate some of the trials which await you as practitioners of medicine. With this hour terminate the tranquil and irresponsible days of your student-life; with this hour commences an anxious, deeply responsible, and life-long struggle with disease and death. Yester- day you were busily engaged in studying the perils which surround the birth of men, the dangers which encompass the lives of ail 7 young children, and the thousand maladies which dog the steps of youth, of the adult and the aged man, as shadows follow the sun. Armed with such knowledge, you go forth to-day the earthly arbiters of life and death. Your vocation is to take care of the sick, and restore them to health ; or, failing this, to palliate their sufferings and prolong their lives. "Glorious your aim—to ease the laboring heart, To war with death, and stop his flying dart; To trace the source whence the fierce contest grew, And life's short lease on easier terms renew ; To calm the frenzy of the burning brain, And heal the tortures of imploring pain ; Or, when more powerful ills all efforts brave, t To ease the victim no device can save, And smooth the stormy passage to the grave." From the Code of Ethics adopted by the American Medical Association you will learn that it is your duty, also, to be ever vigilant for the sanitary welfare of the community, ever ready to counsel the public upon all matters concerning medical police, public hygiene, and legal medicine. It is your "province to enlighten the public in regard to quarantine regulations; the location, arrangement, and dietaries of hospitals, asylums, schools, prisons, and similar institutions; in relation to the medical police of towns, as drainage, ventilation, &c.; and in regard to measures for the prevention of epidemic and contagious diseases: and when pestilence prevails, it is your duty to face the danger, and to con- tinue your labors for the alleviation of the suffering even at the jeopardy of your own lives. You should also be always ready, when called on by the legally constituted authorities, to enlighten coroners' inquests and courts of justice on subjects strictly medi- cal—such as involve questions relating to sanity, legitimacy, mur- der by poisons or other violent means, and in regard to the various other subjects embraced in the science of medical jurisprudence." To follow a calling involving such duties something more than an intimate acquaintance with anatomy, physiology, chemistry, therapeutics, and the principles and practice of medicine, surgery, and obstetrics is required. You must be filled with an exalted sense of the onerous duty, the moral obligation, and the profound responsibility which are inseparably connected with your mission; and jrou must come to the work, moreover, with an earnest, sincere, 8 and truthful desire to promote the interests of medicine—and thereby the prosperity of men—as far as in you lies the power. The most of you are destined, perhaps, to become active private practitioners. Some of you may be called to preside over hos- pitals, infirmaries, asylums for the insane, and the like. Others among you may come to exercise your art in the Army and Navy of your country. To all of you it may happen at any time to be summoned to aid the ends of justice by the exhibition of your knowledge. In all these situations, the comfort and the happiness of many people, for good or ill, are in your hands. Weighty, then, indeed, is the responsibility which, of your own free will, you have this day assumed. Strain your eyes for a moment along the road which lies open before you, and let your mental vision pierce the veil which covers the future. It is midnight. A strong child—an only child, it seems—is struggling wildly, gasping for breath. The smothered cry, the hoarse and brazen cough, grate harshly and ominously upon your ear, for you well know that the inflammatory and rebellious blood' is weaving with nimble fingers the network of death in the throat of that child. And as the frantic mother grasps your hand, and begs you, by all that you hold dear, to stay the destroyer, one glance I catch at your troubled looks, and somehow the scene changes. The houses and streets of a great city are before me. I see men hurrying to and fro, their faces white and ghastly. They shrink from the touch of each other, for the plague-demon holds dread revelry in that town. And the physician is there, pale, haggard, and worn, yet striving manfully to win at least one victim from the jaws of the merciless death. And now the city fades, and in its place, upon the sea, a ship appears, with sickness and despair full freighted. Famine and fever and death have laid their hands heavily upon the crew of that ship; and, amidst the great distress, the conscientious surgeon moves from berth to berth, his intellectual and moral being disturbed and sorely tried, for imminent danger without leagues with perplexity and doubt within to render him the wretchedest of men. Amidst some such circumstances and in the presence of some such spectacles as these the responsibilities of your profession will come upon you with a crushing weight. Into a few moments it will seem to you that the dread, the anxiety, and the embarrass- ment of years have been crowded. In such an hour you will learn that your peace of mind and the comfort and well-being of your 9 patients are interwoven threads, and that the only way to maintain the former is to be thoroughly skilled in all the modes of preserv- ing the latter. I would have you, therefore, to cultivate to its utmost this feeling of responsibility. I would have your sensibilities sharp- ened as acutely as possible. Eesponsibility, rightly appreciated, will cause you to come to the work, not with half-heart, and half- knowledge, and zeal half aroused, but full of devotion, full of determination to be equal, cost what it may, with the requirements of your calling. Face boldly, then, that anxiety begotten of re- sponsibility, and grapple with it resolutely. It is your friend in disguise—a rough friend, it is true, but an honest one—and in the great system of providential compensation, like all dangers to the brave, like all obstacles to the determined, it will become your helper. For this very anxiety is the prolific parent of activity and devotion, and these exerted in behalf of your patients will build you up strongly in the esteem and confidence of the community. The flower ruthlessly beaten down by the storm is yet secretly nourished by the rain-drops borne on the wings of that storm. So your trials and anxieties will ofttimes bring their own recompense, and you, "------like the flower, May bless the cloud when it hath passed away." In entering upon the active duties of your vocation, I wish you particularly to remember that the only wares which you carry into the market of the world to exchange for the goods of life, are your time and professional knowledge. It behooves you, therefore, more than all other men, to economize time, that you may, by its wise use, all the more effectually increase your knowledge. "A man that is young in years," says Bacon, " may be old in hours, if he have lost no time. But," he adds, significantly, "that happeneth rarely." If you rightfully employ those fragments of time so recklessly wasted by the giddy world at large, in the insane quest after pleasure, so-called, you will achieve for yourselves almost any reasonable reputation that you may desire. This diligent and well-directed employment of your time will enable you at forty years of age to have accomplished more than most men who have numbered their threescore years and ten. The golden period of a man's life stretches from his twentieth to his fortieth year. Then it is that bodily vigor and mental activity naturally combine to lay the foundation, if these be judiciously used, of all that is great in the subsequent career of the individual. The most of you have 10 just entered this important period so pregnant for good or evil. The habits of business and study which you now form will de- termine, in great measure, your future history and character. Though not wholly, yet are your affairs largely, in your own hands. Pause, then, and consider what you will make yourselves. The medical knowledge which you now possess must be enhanced by constant reading, and by diligent observation and reflection. As your advancement must depend mainly upon the extent of your medical attainments, you should seize every opportunity of studying, by the bed-side, the diversified phenomena of disease, and the thera- peutic effects of remedies* " The more you know of disease," says Professor Simpson, of Edinburgh, "the more deeply and enthu- siastically you study its phenomena, the greater will be the interest which you will take in every ailment submitted to your charge, in every symptom of it, and in every change in it—an interest cer- tainly altogether independent of, and immeasurably above the in- centive of pecuniary reward, but one that is still, in itself, the surest ultimate road to that very result, because it is the surest means to bind you to your patients, with all that zeal and all that devotion that are so properly considered by the public as alone worthy of such reward." Every case intrusted to your care will demand of you especial study. Not content with what you know, you must ever be on the alert to gather in more knowledge, not so much from books, but rather from the pains, the groans, the throb- bing pulse, the hurried breath, the dry and burning or the cold and clammy skin of your patients. These are the books to which you should frequently turn for instruction. Learn early that your library is in the hospital and the infirmary, on the highway and in the dwellings of the sick. " The great book of nature, which is alike open to all, and is incapable of deceiving," says the celebrated Dr. Parry, "I have hourly read, and I trust not wholly in vain. During the first twelve or fourteen years of my professional life, I recorded almost every case which occurred to me, either in private practice, or in the chief conduct of an extensive charity." I advise you to do the same. Take full notes of your cases; study them by day, and dream over them by night, as the enthusiastic Linnams is reported to have done over a certain shell. In this way only can you make the book of experience thorough and useful for frequent reference. But while you reap with one hand, you must sow with the other. From this book you must read daily lessons of health to the people. From this book you must read lessons of 11 encouragement and instruction to your fellows of the craft. Thus a twofold activity is required of you—activity in the acquisition of knowledge, activity in dispensing it, in employing it with free and generous hand for the benefit of your fellow men. Largely you have received, and as largely you must give. Grain in the mill comes forth flour to feed the hungry thousands. So your knowledge must go forth to the healing of many. Let me exhort you to cultivate diligently the habit of writing. It will do much to define and render accurate your knowledge. As enlightened and grateful physicians, your duty is not fully per- formed if you do not assist in cultivating the literature of your profession. This literature has been slowly, painfully, and labo- riously built up in the ages—built up at the cost of the money, the time, the sleep, and the brains of many worthies who now rest from their labors, and of some living upon whose shoulders the mantle of Elijah has fallen. What would you be without this literature, this long record of valuable facts? Very helpless chil- dren groping in the dark, groping blindly. Can you vaccinate a child without thanking God that there once lived a man called Jenner ?—a man who, despite the opposition of his medical con- temporaries, and the contumely of an ignorant people, worked out and placed upon record a great discovery. Every man, woman, and child saved by this discovery from a dangerous and loathsome disease, becomes a living, moving witness that Jenner filled up the measure of his duty to overflowing. When you break up the paroxysms of an intermittent fever with Peruvian bark, are you not grateful to the Countess of Cinchon and the old Cardinal de Lugo for having labored so zealously to disseminate a knowledge of the valuable properties of this drug ? Can you ligate an artery, and so arrest hemorrhage, without feeling indebted to Celsus, and Albucasis, and especially to Pare? Can you repair a deformed face by a plastic operation without dropping a word of praise to the memory of Tagliacotius ? If you cure an aneurism by tying the arterywhich feeds it, does not John Hunter seem to be treating the patient with your hands? When you explore the chest of one whose lungs are emphysematous, or the seat of tubercle, or who suffers from a pericarditis, are you not thankful for the strong light which has been shed upon your path by a Louis and a Laen- nec? When, by the aid of the laryngoscope, you diagnosticate some disease of the larynx which has hitherto baffled all efforts at its elucidation, does not the name of Czermack seem to be reflected 12 in brilliant characters from the mirror in your hand ? When you suddenly, I had almost said magically, relieve one suffering from a fierce paroxysm of neuralgia, by means of the hypodermic use of morphia, is not your satisfaction at the relief of your patient mingled with gratitude to Alexander Wood, to Kursack, and C- Hunter ? Can you procure for a fear-stricken patient the blessed sleep of anaesthesia, preparatory to amputating a limb or perform- ing any other capital operation in surgery, without extolling the name of Morton ? On the other hand, when the names of Rau, Ruysch, Roonhuysen, Bcekelman, and Chamberlen are mentioned, are you not filled with abhorrence at the illiberal spirit which caused these men to keep back from their medical brethren the valuable secrets and inventions which their genius placed in their hands ? Publish, then, to the profession, any discovery or improvement in medicine or surgery that you may be so fortunate as to make. To withhold such knowledge is to become a miser in deed if not in intent. Do not say that you cannot perform this duty because, though burdened with time when young, you have no experience; and that with advanced age and much business and experience comes the destruction of time. If you would become really great and meritorious physicians, you must abandon this notion now and forever. If you are true to yourselves, you will never forget that young men are the apostles of all new truths the world over. Very justly wrote Bacon: " The invention of young men is more lively than that of old, and imaginations stream into their minds better, and, as it were, more divinely." The records of medicine and of science in general—records of which the public, unfortu- nately for you, is profoundly ignorant—teem with the proofs of this proposition. In his 23d year, Vesalius, the father of human anatomy, was appointed by the republic of Venice to teach this science in the University of Padua. And he did teach it, and in such a manner as to shed more lustre upon his chair than he de- rived from it, very young though he was. In his 29th year he published the greatest work on anatomy that the world, up to that time, had ever seen. The illustrious Harvey, we are told by one of his biographers, was probably occupied in the beginnino- of his career, like young physicians of the present day, among the poor in circumstances, and afflicted in body, taking vast pains without prospect of pecuniary reward. Yet, when chosen in his 37th year to lecture upon anatomy and surgery before the College of Physi- 13 cians, he presented, in his very first course of lectures, a detailed exposition of those views concerning the circulation of the blood, which afterwards made his name immortal; views which he must have been developing long before their enunciation; views which were adopted, it is said, by none of his cotemporaries who had attained the age of forty years, but which had to win their way under the safeguard of the youthful and unprejudiced spirits of 1628 and 1630. Bichat, whose laborious researches are declared by the late Mr. Buckle, in his " History of Civilization," to consti- tute in their actual and prospective results the most valuable con- tribution ever made to physiology by a single mind, died in his 31st year. Cuvier, whom Knox calls "the first of all descriptive anatomists, contributed to the literature of zoology in his 23d year, valuable papers on insects, crustaceans, and molluscs. He published his memorable "Lecons d'Anatomie Comparee" in his 31st year, and in that year became a lecturer upon his favorite science in the Jardin des Plantes. In his 26th year Agassiz had already com- menced the publication of that great work, the " Poissons Fos- siles," which gained for him the respect and admiration of the scientific world. The celebrated Portal was but 26 years of age when he published his " Precis de Chirurgie pratique." Dupuy- tren commenced his literary labors in his 27th year by the publi- cation of "Propositions sur quelques points d'Anatomie, de Phy- siologie, et d'Anatomie pathologique." In his 25th year Scarpa published in elegant Latin an "Essay on the Anatomy of the Ear." Desgenettes, when 27 years old, made the occasion of his entrance into the medical profession memorable by the publication of his " Tentamen Physiologicum de Vasis Lymphaticis," and by demon- strating, amidst the applause of the assembled professors, the injec- tion of the lymphatic system. Laennec signalized his 23d year by the publication of a thesis on the Hippocratic doctrines relating to practical medicine, and by a memoir upou helminthology. It is upon record that Sir Isaac Newton brought forward his doctrine of light and colors before he was twenty; that Bacon wrote his " Temporis Partus Maximus" before he had reached that age; that Montesquieu had planned his " Spirit of Laws" at an equally early period of life; that Jenner, before his 20th year, was already en- gaged in developing his great discovery; that Linnaeus, while yet in his boyhood, dimly conceived his famous botanical system ; that Cuvier, before he attained his 25th year, and while yet in Nor- mandy, with nothing but nature and the " Systcina Naturae" of 14 Linnaeus as his guides, was seized with the idea of comparing fossil remains with the existing fauna, an idea with which, in the form of a memoir upon fossil and living elephants, he signalized the first public session of the National Institute of France; and that Humboldt, by the publication of his " Observations on the Basalts of the Rhine," in his 21st year, had already entered upon his well-known and wonderful career of enlarging the boundaries of human knowledge, and rendering his name the synonyme of all that is grand and interesting in physical science, just as his great prototype in antiquity, Aristotle, had, twenty-two centuries before, become identified with the domain of natural history. " Who," wrote Professor Stille, in 1848, " has produced the most perfect treatise extant on pneumonia? The only complete history of the diseases of children ? The only consistent account of neuralgia ? The most perfect history of cancerous diseases ? The first true statement of the pathology of hydrocephalus; of softening of the brain ; of remittent fever ; of tubercles of the bones; of alterations of the urine; of infantile pneumonia? Such men as Grisolle, Ril- liet, Barthez, Valleix, Walshe, Rufz, Gerhard, Green, Durand Far- del, Stewardson, Nelaton, Becquerel, and so on. All of these, with a single exception, are young men, and yet the authors of works which by common consent are placed in the foremost rank of the medical authorities of the present day." Trust me, the wants of an age are always represented by the dreams and aspirations of its youth; and the ambitious longings of the young, at once prophetic and provident, work out their own best answer as the present foreshadows and moulds the future. When, therefore, the doubting world, in its thick and stolid igno- rance, flings your youth into your very teeth, as proof positive, that you lack experience and skill, and that there is no good thing in you, be not cast down, but take heart from these examples, and heeding not the opinions of men, lay your hand determinedly to the plough, and learn to labor and to wait for the slow but certain consummation of your hopes. If you would obtain the confidence of the world, you must have confidence in yourselves, you must be animated by the same spirit which impelled Cgesar to say to the affrighted pilot in the storm, " Fear not, thou carriest Ceesar and his fortunes;" or that actuates Bulwer's Richelieu, when, in the midst of adversity, he exclaims:—■ " ■------------my triumphant adamant of soul, Is but the fixed persuasion of success." 15 Such a spirit will carry you hopefully and patiently through the struggles and difficulties of the lonely period of probation upon which you have just entered. Some there are in our profession who have found a short and easy road to a lucrative practice by inheriting it from a father, a father-in-law, or some other relative who may be extensively engaged in business; or, by obtaining it through the timely patronage of some over-busy practitioner who seeks relief from his incessant labors. Such men have success, in great measure, thrust upon them. The most of you will be com- pelled to earn it—to win your way to a remunerative practice through many trials, and by triumphing over many obstacles. The biographical literature of medicine is filled with examples of this fact, which should become incentives to you. The celebrated Dr. Physick, who commenced his professional career in the 25th year of his age, and after eight years of preliminary study at home and abroad, said of himself, " I walked the pavements of Philadel- phia, after my return from Europe, for nearly three years without making as much by my practice as put soles on my shoes, and such were my discouragements and dissatisfaction that I would have sold the fee simple of my profession for a thousand pounds, and never again have felt a pulse in the capacity of a physician." And yet, despite an unsociable and reserved nature, not at all cal- culated to attract patients, he, by his scientific abilities alone, won for himself the proud title of the Father of American Surgery. His professional labors produced large incomes, year after year, and finally secured for him a fortune of more than half a million of dollars. His great British cotemporary, Sir Astley Cooper, we are told by Professor Simpson, lived while attending lectures at the University of Edinburgh, in 1788, in a room which cost him six shillings and sixpence a week. A year after he had settled in London, and engaged in lecturing on anatomy and surgery, his receipts from private practice amounted to five guineas only. And yet it came to pass, in after years, when he had become the leader of surgery in London, that his income in one single year amounted to £23,000. His successor, the famous Sir Benjamin Brodie, lec- tured, practised, and published, from 1805 to 1825, a period of twenty years, before he got into full practice. " I well remember," wrote this eminent surgeon, "how often, in the intervals of occu- pation, I have contemplated, with something like dismay, the pros- pect which lay before me." In like manner, that able and busy practitioner, Dr. Matthew Baillie, who in one year received fees 16 amounting to more than £11,000, had been already for twelve years physician to St. George's Hospital, and for nearly twenty years a medical lecturer before he found himself fairly established in medical practice. From among the living practitioners of this country, nay, of this very city, I might readily cite many similar examples to show you how invariably success treads closely upon the heels of patient, persevering effort. When, at length, you have secured success—when in the course of time your self-reliance, your diligence and skill, have brought you much business, and made you thereby the slave of the sick public, think not to say, now I will rest, now I will take mine ease. Over many there are in the world who are resting and taking their ease, living upon the labor of others, and returning to the world not a tithe of what they have obtained from it. Think you Frederick Hoffman rested much while writing those numerous folio volumes, the mere titles of which, as Haller informs us, would fill many quarto pages? Think you Hermann Bcerhaave, who, in his younger years, was compelled to earn his living by teaching mathematics while studying medicine, could have enjoyed much leisure while delivering yearly separate courses of lectures on the theory of medicine, the practice of medicine, botany, and chem- istry, besides giving clinical lectures three times a week in the midst of a busy practice that must have consumed a very large amount of time, since he accumulated thereby a fortune of two million florins in thirty-five years? Think you Sir Astley Cooper could have been much concerned about his ease, seeing that he published some of his most valuable works during the time in which he was more occupied than any professional individual had, perhaps, ever been ? Did not the celebrated Mason Good translate, in the streets of London, that majestic poem of Lucretius, on the " Nature of Things," during his extensive walks to visit his nu- merous patients ? Was not Dr. Willis, while translating the works of Harvey, and writing the biography of that brilliant physiologist, " incessantly engaged by night and by day in the laborious and responsible duties of a country practice, enjoying nothing of learned leisure, and snatching from the hours that should ricrht- fully be given to rest, the time that was necessary to composition ?" Look into the annals of a sister profession, and behold Sir Matthew Hale, the eminent English jurist, finding time, in the midst of his herculean legal labors, and in his 66th year, to write a work on " The Primitive Origination of Mankind." In the preface of that 17 work I find these noteworthy words: " It was written at leisure and broken times, and with great intervals and many times hastily, as my busie and important employment of another nature (known to the world) would give me leave." But why multiply examples to show you what you can do, if you will; what you should do, if you would perform rightly your duty ; what you will do, if you are true to the grand and im- perishable instincts of your being. Many there are who will laugh at your efforts, and pronounce them incompatible with the so-called practical duties of your profession. When such speak to you of impossibilities, your answer is plain. It is the answer of Tell to the boatman, when the latter said, "It is impossible to cross the lake in such a storm as this." " I know not," said the Alpine Hero, " whether it be impossible, but I know that it must be attempted." Though I urge you to the zealous cultivation of purely medical studies, do not make the mistake of supposing that you should read and think of nothing but disease and the remedies for its relief. The tendency of such injurious devotion is to contract the mind and shut out from it those large and comprehensive views of your profession and its relations which you should always seek to obtain, and which you can obtain by the observation and comparison only, of many and diversified facts. The mind is best disciplined and strengthened by a certain well-regulated variety of study. Rightly considered, this variety is a form of rest and recreation; and these the mind requires as well as the body. The continuous monotone of falling water wearies the ear insufferably, and sleep visits the eye too long fixed on the waving grain. So the mind exerted over- long upon one subject loses its vigor and becomes listless and apathetic. From time to time during your career, therefore, especially in the early days of probation, and of that hope deferred which makeih the heart sick, you may occasionally turn your attention with much profit to the collateral sciences. They will serve to enlarge the range of your mental vision. Medicine, it is true, is not a science. Though its infancy was passed in the rough cradle of experience, its vigor- ous manhood must be sustained by science. Hence, to be truly rational, and, therefore, regular practitioners, you must endeavor, as far as possible, to practise and to cultivate your profession as scientific men. For the medical profession during twenty centuries has always industriously cultivated and been the chief promoter of natural knowledge. At the present time those sciences which, in their relation to medicine, are styled "accessory," have acquired 2 18 so much importance in the gradually expanding system of medical education, that laboratories, not only of chemistry, but also of physics, physiology, and histology, are being founded in connection with the leading medical schools. A Faculty of Biology has already been installed in the Faculty of Medicine at Paris. In the crowded middle walks of our profession, however, the scientific claims of medicine are scarcely recognized; among the people they are un- known. Hence the latter, having no standard by which to judge between the true man and the impostor, are constantly being jug- gled into the arms of death, not as they fondly suppose secundum artem, but in reality secundum ignorantiam. If you would become physicians in the highest acceptation of the term you must be deeply impressed with the scientific require- ments of medicine. The welfare of your patients and your indi- vidual interests alike demand this; for as long as medicine continues to be purely empirical, so long will quackery be possible. This baleful parasite flourishes most vigorously in those departments of our art least illuminated by the rays of science. Surgery, resting upon the exact science of anatomy, and calling to its aid various accurate mechanical appliances, is now but little troubled with im- postors. The "natural bone-setters" and other similar charlatans have long since disappeared from its domain. Practical medicine, on the other hand, based as it is upon an experience which is so often fallacious, upon a physiology and pathology still very imper- fect, and an organic chemistry in a state of great confusion, is still a prey to the mercenary cunning of every quack who boasts his infallible remedy for phthisis, rheumatism, and all those special ills which, in consequence of our ignorance of their essential nature, continue to resist all therapeutic effort. In view of this fact it is incumbent upon you to do all that you can to render quackery impossible, not by exposing its criminal falsifications, but by making that which is doubtful in medicine certain, and that which is obscure clear. To do this you must emphatically recognize the fact that medicine has a twofold rela- tion ; that it touches science on the one hand and humanity on the other; that it depends upon, and must keep pace with, science in order to deal skilfully with the sufferings and sorrows, both physi- cal and mental, of mankind. Herein lie at once the difficulty and the glory of the physician. For the sufferings and sorrows of humanity resolve themselves into questions of the necessity of food, warmth, and clothing ; of climatic conditions and their infiu- 19 ence ; of health and sickness; of wealth and poverty; of labor and idleness; of luxury and frugality; of advancing civilization and increasing vice; of yearnings after the beautiful and good strangely coupled with exposure to misery and crime and their attendant degradation. Some of these problems you can investi- gate by the clinical method peculiar to medicine; for the solution of others you must call to your aid the methods and appliances of physical, chemical, and natural science. You, who are fresh from your studies, know with what unexampled rapidity science is ad- vancing, unfolding itself in a multiplicity of directions, like the numerous branches of some lofty tree. The momentum of this active development has been imparted to medicine with happy practical results. By means of various ingenious scientific appli- ances, such as stethoscopes, laryngoscopes, ophthalmoscopes, oto- scopes, endoscopes, microscopes, thermometers, manometers, the sphygmograph of Marey, the stetho-sphygmograph of Hawkins, different electrical machines, &c.—the laws of sound, light, heat, electricity, and mechanics have been practically employed, in not a few instances, with signal success, in elucidating the phenomena of disease. In consequence of this rapid advance in science, and the multiplication of scientific instruments, medicine is, at present, undergoing a remarkable change. While its data are daily becom- ing more and more exact, the theories or fundamental principles which constitute its framework, so to speak, are undergoing a complete revolution. To the reflecting mind it is evident that medicine is now passing through a chaotic phase in its onward career. The day of blind obedience to authority is at an end. No asserted fact, no theory, however plausible, finds its way to accept- ance on account of the great name attached to it, but, on the con- trary, is immediately tried in the crucible of experiment, observa- tion, and induction. But medicine, in becoming scientific, has grown sceptical. The twin-brothers Doubt and Disbelief are even now pulling up, and with no gentle hand, the ancient landmarks all around us. The iconoclasts are at work. Opinions and conclu- sions are being sifted so fiercely that we at length stand face to face with the danger of denying altogether the accumulated expe- rience of our fathers. " What is certain in respect of medicine critically considered as a science and as an art," says Prof. Acland, "may be thus stated: There is a true medicine and a false medi- cine. Like the wheat and the tares, they now stand together. The true is that which is based on unalterable laws of nature ; the false 20 that which is the result of ignorance, unconscious interpretation, or wilful error—ignorance of nature, unintentional misunderstand- ing of her laws, wilful falsification of facts, to subserve some tem- porary purpose. From these two, the true and the false, come all the traditions of our art. To winnow the one from the other, to extrude the uncertain from the proved, to add to what is known, regardless of the effect on previous beliefs, is the special duty of the time in which we are now placed. If this duty were com- pletely done, we should possess the real history of an art three thousand years old." This is your duty. You enter the profession at a critical period. You leap upon the deck of our vessel in a swift running stream filled with the shoals and quicksands of false facts and false theories. You must put your hand to the tiller and aid in delivering us from these dangers. You must become one of that earnest band, whether in physics or biology, who, with busy hands, are seeking to reconstruct the philosophy of medicine, and place it upon a sure scientific basis. And this basis, it is now beginning to be seen, is to be made up of the accumulated and well-examined facts relating to the chemical circulation of matter, the conservation of energy, and the development of organic forms by natural selection. For these facts, though they have not yet proved fruitful to medicine, nevertheless warrant us in indulging the hope of a certainty for our art, with which we have hitherto been strangers. For they show us a constantly increasing proba- bility that living beings placed in similar conditions will advance in similar lines, and conversely. The study of this biological gen- eralization or law, in some of its multitudinous details, is destined perhaps to reveal to us why certain diseases run a special course in certain families, and how, consequently, knowing the conditions, we can proceed with philosophical and hopeful assurance to arrest the progress of such diseases. It is destined to give certainty to both curative and prophylactic medicine. In it centers the hope of all future progress in therapeutics and pathology. A vulgar prejudice, I am aware, prevails against the cultivation of science by a physician, and this prejudice, I am sorry to think, is kept alive by certain of the " baser sort," who " Make sordid wealth the object, and sole end Of their industrious aims." To a considerable extent scientific investigation is not only com- patible with the active, daily duties of the physician, but in reality 21 by inculcating close and accurate habits of observation very often becomes a guarantee of success in the performance of those duties. The truth of this you may learn from the lives and labors of Hunter, Baillie, Prichard, Morton, Drake, and many others whose names I might mention. The celebrated Doctor Baillie of London was frequently advised to abandon his anatomical pursuits lest they should interfere with his prosperity as a practitioner. This he wisely refused to do, and ultimately this very knowledge ren- dered him vastly superior to those who attempted to compete with him in practice. Sir Hans Sloan, the favorite physician of Queen Anne, was regarded as one of the greatest naturalists of his day; yet it is recorded of him that his " great scientific attainments did not act as a bar to his professional advancement, for his practice was very extensive." John Hunter, the surgeon-naturalist of the 18th century, and the "author," as he has justly been called, "of a new era in the history of our profession," found time in the midst of his laborious and successful practice to publish many treatises upon practical surgery, anatomy, physiology, and natural history, and to lay the foundation for that natural classification of the animal world which Cuvier afterwards effected. The celebrated Dr. Prichard is extensively and chiefly known to the world by his voluminous researches into the physical history of mankind. Yet we are informed by one of his biographers that he applied himself with much zeal to the practice of his profession ; that he established a dispensary and became physician to some of the principal medical institutions of Bristol; that he had not only a large practice in his own neighborhood, but was often called to distant consultations, and that notwithstanding the engrossing nature of these occupations. he found time to prepare and deliver lectures on physiology and medicine, and to write an essay on fever, and one on epilepsy, and subsequently a larger work on nervous diseases. The late Dr. Morton, also publicly known as an ethnologist, amidst the onerous duties of an extensive medical practice, which was steadily in- creasing up to the time of his death, could find time to deliver lectures on anatomy, to serve the Philadelphia Hospital as con- sulting physician, and to publish his two brilliant craniological works, and numerous detached papers on ethnography, hybridity, and allied subjects, in addition to a valuable work on phthisis, and one on anatomy. Dr. Daniel Drake, that " zealous apostle of sci- ence," as an English reviewer has well called him, amidst the incessant occupation entailed upon him by his practice and his 22 lectures, was enabled by a wise economy of his time, to bequeath to the world, at his death, a work which has justly been regarded as "one which would do honor to any country." But while I thus endeavor, by these examples, to stir up in you a noble ambition, I must warn you to commence your career by binding yourselves, Ulysses-like, to the mast of your profession, lest in your occasional incursions into the domain of science, the voice of the siren estrange you wholly from your first love, and ruin your prospects as medical men. You are physicians, and as such in these days of jealous rivalry and competition, yOu need not expect to attain great reputation as chemists, naturalists, &c. He who is ambitious of such eminence must work long and hard, and uninterruptedly. The details of your profession are so nume- rous that the acquirement of tbem will severely tax your capacity for labor; and the demands of your patients, sometimes necessary, sometimes frivolous, sometimes in season and very often out of season, will effectually destroy your leisure. Moreover, you must never lose sight of the fact that you acquire knowledge only to use it. " Add to the power of discovering truth," said Sydney Smith, "the desire of using it for the promotion of human happiness, and you have the great end and object of our existence." The true strength of the physician lies not so much in vast and bril- liant acquirements, as in the extensive and successful application of a certain amount of solid and well chosen knowledge, which has been so thoroughly incorporated into his mind that he can use it readily upon all occasions and at the shortest notice. Super- abundant knowledge in a physician—that is, more than he knows how to use efficiently—is frequently an incumbrance rather than an aid to him. Hear what Dr. Latham has thoughtfully and prac- tically said upon this subject: " My experience of human life has long since convinced me that the number of truly learned and scientific men in the world is small. Therefore, real learning and real science must be things of difficult attainment, since so many are engaged in their pursuit. But be their attainment ever so difficult, it is not half so difficult as their use.....I am ac- quainted with men who never have done, and never can do anything because they know too much; and I am acquainted with men pos- sessing comparatively small knowledge, so dextrous in its use that they have ridden over the heads of others far, very far, their supe- riors in acquirement.....Fortunate, indeed, is the man who takes exactly the right measure of himself, and holds a just balance 23 between what he can acquire and what he can use, be it great or small." Disease being cosmopolitan, and no respecter of persons, you will be called upon to mingle freely with all grades of people, at all times, in all places, and under all circumstances. Evil men there are on the road with hurts to be healed; wretched beggars in cel- lars and dens with fevers to be subdued; poor artisans in hovels with pains to be assuaged. You must prepare to heal, subdue, and assuage these hurts, these fevers, and these pains. But the moral, the intellectual, the refined, and the cultivated also have their hours of sickness and sorrow in which your sympathy and aid will be most anxiously sought. Therefore, you must take by the hand the disease-stricken sons and daughters of poverty, sin, and shame, as well as the favored children of wealth. But I perceive danger here and temptation, and would earnestly warn you of these "break- ers ahead" in the deep water of your opening career. Let me advise you, then, in treating the sick kindly, and with much attention, to be very careful how you make familiars and associates of them all. Your active sympathy will beget friends everywhere, for friendship and sympa- thy are correlative and contagious. But look well to it that you take but few of these so-called friends into the secret councils of your soul. Sooner or later some of them will betray you when you least expect it. Now good and great men are the salt of the earth; only they make it sweet and wholesome. The knowledge that such are your friends raises your credit, and gives you character with the world. If it happen to such to be sick and in your hands, look well that you diligently cultivate their respect and good-fel- lowship. It will repay you abundantly, for by being much in their company you will acquire the secret of their excellence, and exhibit it in your own actions. The great Napoleon knew this when he said: "You must not fight too often with one enemy, or you will teach him all your art of war." Emerson has the same idea. "Talk much with any man of vigorous mind," says he, "and we acquire very fast the habit of looking at things in the same light, and on each occurrence we anticipate his thoughts." Under the invisible, but potent rays of the sun, all vegetation is urged into blossom and fruit. So the continued presence of intellectual and moral excellence arouses into blooming and fruitful activity all the great and moral capabilities of the mind. Right pleasant it is to gaze upon a comely maiden, a beautiful picture, or the marble that some cunning hand hath chiselled well-nigh into life. 24 The eye takes in such to the wholesome nourishment of the soul. The frequent contemplation of mean actions, and of low, disgusting objects, tends to deform and warp the soul clean from its high and holy purposes. Everywhere there is assimilation. Good apd evil engender their like continually. This truth it deeply concerns you of all men to know and to feel, for your mission is to all sick peo- ple, and many sick are wicked to the last extreme; often more cor- rupted in mind than diseased in body. When such obtrude them- selves upon your path, and with uplifted hands supplicate your therapeutic aid, you dare not turn aside, nor stay your hand from the healing. This humanity forbids. This your own conscience would condemn. Bind up, then, the wounds of these wretched and pour in oil and wine, but in so doing take heed " That the immaculate whiteness of your fame Shall ne'er be sullied with one taint or spot." While you perform your part as skilful physicians, let the light and warmth of your moral excellence illuminate and vivify all about you. Let impurity ever stand abashed in the presence of your purity, and immorality cast down its eyes under the earnest look of your morality. In the remote infancy of medicine they who took the Hippocratic oath swore by Apollo, the physician, and .iEsculapius, and Hygeia, and Panacea, with purity and with holiness to pass their lives and practise their art. And the Code of Ethics adopted by our Medical Congress strictly enjoins upon you the cultivation of purity of character, and a high standard of morality. Against another temptation I must fortify you. You will leave this hall to-day full of confidence in the honesty, the gratitude, the friendship, and benevolence of mankind; and secretly elated, per- haps, at the prospect of becoming the recipient of the respect and admiration of men, in virtue of the dignified and honorable pro- fession which you have chosen. Ere the snows of but a few winters have whitened your path, this confidence will beo-in to be shaken, and unless your experience be very different from that of most men, you will earlier or later be forced to the conclusion that honesty and gratitude, though very valuable, are also very rare virtues, and that honor, friendship, and benevolence too often " Are the soft, easy cushions, on which knaves Repose and fatten." 25 For as your business increases it will not unfrequently happen that many days of faithful attendance and nights of sleepless watching on your part, will be completely ignored by some of your patients, and your conscientious and judicious efforts in their behalf requited with the basest ingratitude. He to whom you hastened, regardless of your own health, through the pitiless storm of a winter's night, to relieve of a dangerous hemorrhage, an apoplectic seizure, or a suffocating asthma, will not only not re- munerate you, though amply able to do so, but even when he en- counters you on the street, pass by, like the Levite, on the other side, looking all the while earthward, heavenward, to the right or the left, or in any direction save yours. She whom you assisted during the throes of labor, or to whose child, when seized with convulsion or croup, you ministered through the long, long, weary night, will forget not only your services, but, it may be, your very name. Does this seem incredible to you? Any busy practitioner will confirm my words. Listen to the recorded experience of an accomplished and venerable physician of this city, recently de- ceased, who for nearly half a century, in both the country and the city, dispensed the blessings of his art. " After a long, and, as I believe, an honest contemplation of mankind," said Dr. Samuel Jackson, of Northumberland, address- ing the physicians of Philadelphia, from the presidential chair of the Philadelphia County Medical Society, " I am fully convinced that they do not justly appreciate the hearts and minds of physi- cians; for if they did, ingratitude would not prevail so rankly. You may have faithfully attended a family for many years, have apparently and confessedly saved one or more of them from an untimely grave; you have heartily participated in all their joys and sorrows; you have watched whole nights at their bedside, your heart torn with anxiety for the fate of a wife, a husband, a parent, or a child ; you have freely mingled your tears with theirs, when the cold sweat appeared on your patient's brow; but, alas, a slight offence, merely one unlucky word, and all your long ser- vice is forgotten. Here, then, prepare your generous soul for temptation ; for just in proportion to your faithful affection, sorrow now will sink deep and sadden your heart. " It often happens that you have attended a poor family for years, and also their various poor relations; let those miserable people succeed to affluence, and they know you no more. Some phvsician who has not seen them in their humility, is sure to be called 26 to the rising family; ' more certainly,' says Dr. Rush, ' if at any time they have been the objects of your private beneficence. This will not surprise us,' says the doctor, ' when we recollect how forci- bly the presence of the physician is calculated to remind them of the wooden hut or small and dirty apartments in which he first visited them.' If the children of this poor family rise to affluence, they are certainly far above ordinary mortals if they wish to see you again. Their abandonment of their old physician is the more certain, if he remain poor ; they throw him off as they do their old houses and furniture, things unsuitable to their new and more brilliant relations in life. "Should any family be unable or unwilling to pay your long accumulating bills, they suddenly leave you and employ another physician. If a wondering neighbor inquire the reason, they are sure to give you a bad name. Then follows their implacable hatred ; for it is justly observed by Tacitus, that men always hate those whom they have injured. . . . " Patients, in order to escape the payment of at least a portion of their bill, will sometimes detract from the merit of your ser- vices. You have attended a patient through a serious illness and have left him perfectly restored ; some weeks or months elapse before you see him again, when he appears to your gladdened eyes to be in perfect health. Well, my friend, I am glad to see the roses in your cheeks. Yes, doctor, but I have had a poor time of it since you left me; I got no better till these three or four days past when I began the use of maple sugar, and I think it has done more for me than all your medicine. . . . "It will sometimes happen, even among your friends, that you are secretly defrauded of your just praise. You have struggled laboriously and anxiously through a most difficult and dangerous case, and while you secretly glory in the success of the Hippocratic art, you find the cure is imputed to the sly interference of a busy neighbor. Sometimes, when a dangerous case is unexpectedly cured, the friends will gravely observe that the patient was not so ill as he was supposed to be, as though death was the only criterion of danger, or, as though no fatal case could be saved by medicine. " If you have been particularly successful in an epidemic fever, if there have been fewer deaths in your village than in those of neighboring doctors, your very friends will gravely tell you that the disease has been less violent. In this there is much temptation, but you cannot say nay without reflecting on the merits of your 27 brethren. What can you do? Nothing, nothing, but follow the advice the jailer gave Socrates a few minutes before sending him the poison : ' Try to bear this unavoidable evil as lightly as pos- sible.' " Having repeatedly suffered from the slow, but wearing, because long-continued irritations just referred to, having practically learned the truth of Dr. Johnson's observation " that the misery of man proceeds not from any single crush of overwhelming evil, but from small vexations continually repeated," then will come the struggle for which I must prepare you. Having, in despite of your generous impulses, and the better feelings and resolutions of this hour, lost some of your early respect for mankind, you will find it not a little difficult to keep alive that active spirit of benevolence without which all your efforts to relieve the sufferings of men will be weak and unavailing. Day following day will find you drifting hopelessly towards the cold and apathetic sea of misanthropy, in hourly danger of making shipwreck of your happiness for life. If you would escape such a disastrous result you must take broad and elevated views of your profession and its duties on the one hand, and of humanity and its wants on the other. Your pro- fessional studies must be based upon a deep and abiding love for their intrinsic excellence, and not upon any foolish and vain-glo- rious notions of the consideration and respect which they will bring you ; and you must practise your art, not to satisfy a craving- thirst for gain, but because of the noble and unlimited oppor- tunities which it affords you of doing good. "I have afways thought it a greater happiness," said Sydenham, " to discover a certain method of curing the slightest disease, than to accumulate the largest fortune." " My only wish," wrote the good Doctor Fothergill, and I pray you to heed his words, " was to do what little business might fall to my share, as well as possible, and to banish all thoughts of practising physic as a money-getting trade, with the same solicitude as I would the suggestions of vice or intem- perance. ... I endeavor to follow my business because it is my duty, rather than my interest; the last is inseparable from a just discharge of duly ; but I have ever wished to look at the profits in the last place, and this wish has attended me ever since my be- ginning." And again he says: "I wished most fervently, and I endeavor after it still, to do the business that occurred, with all the diligence I could, as a present duty, and endeavored to repress any rising idea of its consequences; such a circumscribed, unas- 28 piring temper of mind, doing everything with diligence, humility, and as in the sight of the God of healing, frees the mind from much unavailing distress and consequent disappointment." In these philosophical words I find the secret of contentment and happiness for the physician—the true and only talisman by which you can avert the poisoned shafts of envy, ingratitude, and misrepresentation. I urge upon you, therefore, not only for the benefit of those with whom you are hereafter to have business relations, but for your own sake, to make every exertion to attain that high ethical culture which will cause you to experience real, unalloyed pleasure in doing good, irrespective of any secular reward that may result from the good action. If the latter, which may be justly your due, is withheld, or, worse still, if, through some perversion of human nature, positive injury to yourself is the result, the spirit of beneficence, of which nothing can deprive you, still remains in all its sublime grandeur, constituting an im- pregnable armor which, more than anything else, will carry you unscathed through the petty annoyances incident not only to your profession, but to all the affairs of life. Let the words and the successful careers of Sydenham and Fothergill encourage you, then, to do your duty, nothing doubting, and troubled neither about the reward nor about the dignity and honor. The first will come of itself in due time, and the last two are the veriest phantoms if they spring not into existence from your own acts. If you would be revered by men, you must get a firm hold upon their affections, and to do this you must show them that you are competent and ever ready to relieve them in the hour of their bitter anguish. You must show them that you are " a man, and no stranger to the cries of humanity;" that you sympa- thize with and love them ; that you put yourselves to much trouble, and take infinite pains, and make material sacrifices in their behalf. With such feelings and principles, with such a worthy ambition constituting "The vital axle of the restless wheels That bear you on," go forth into the world resolved to work for humanity—for man in the ages; go forth expecting to be tried and misrepresented and betrayed in divers ways by individual man; go forth with the abiding consciousness that you are called to a great work, and that these trials are the necessary accompaniments to the performance of this work; go forth with the conviction that the race is not 29 always to the swift, nor the battle to the strong, but to the resolved and the persevering; go forth into the battle of life "deliberately and persist obstinately, and be very slow to find out when you are beaten;" go forth looking for assistance neither to the right hand nor to the left, but self-reliant, earnestly believing in your own energies, "heart within and God o'erhead." Forth into the world, and in all your future strivings, in all your labors, in all your pains and pleasures, may the strong right arm of Jehovah Rophi— the Lord the Healer— " Before, behind you, and on every hand Enwheel you round." ( GRADUATES JEFFERSON MEDICAL COLLEGE OF PHILADELPHA, MARCH, 1870. At a Public Commencement, held on the 12th of March, 1870, the Degree of Doctor of Medicine was conferred on the following gentlemen by the Hon. Edward King, LL. D. President of the Institution, after which a Valedictory Address to the Graduates was delivered by Prof. Meigs. name. Abbott, Benjamin T. Albert, John V. Attaway, Thomas Mutter Atlee, W. Lemuel Barclay, John W. Barnes, Robert H. Bartleson, Henry C. Beckwith, Frank Edwin Belo, Arthur F. Betts, J. M. Black, Clarence E. Blacbly, S. L. Bowen, John James Brayton, E. Cnllen Breneman, M. B. Briggs, B. B. Brown, J. Jordan Bruekart, W. Scott Buckby, Wilson Butterfield, Thomas H. Campbell, Charles Chessrown, A. V. Clark, E. W. Collings, Posey Crenshaw, John W. Crook, Joseph A. Davis, John B. Davis, Thomas D. Detweiler, Moses H. Dickson, S. Henry, Jr. Dellenbaugh, Z. T. Donaldson, S. J. Duudore, Frank P. STATE OR COUNTRY. New Jersey. Pennsylvania. Texas. Pennsylvania. Alabama. Pennsylvania. Pennsylvania. Connecticut. North Carolina. Idaho. Canada. Pennsylvania. Pennsylvania. New York. Pennsylvania. Michigan. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Vermont. Indiana. Kentucky. Tennessee. Pennsylvania. Pennsylvania. Pennsylvania. South Carolina. Ohio. Vermont. Pennsylvania. SUBJECT OF THESIS. Blood-Letting. Acute Dysentery. Malaria a Cause of Hemorrhage. Differential Diagnosis of Ovarian Dropsy and Ascites. Puerperal Fever. Scarlatina. Chronic Metritis. Anaemia. Drunkenness. Syphilis. Nausea Marina. Inflammation. Philosophy in Medicine. Anthropology as related to Medi- cine. Gonorrhoea. Fevers. Sleep. Hectic Fever. Variola. Scarlatina. Rubeola. Cholera Infantum. Typhoid Fever. Rubeola. Phthisis Pulmonalis. The Diagnosis of Inflammation. Hectic P^ever. Medical Fallacies. Respiration. Diphtheria. Theory of Tubercle. Vis Medicatrix Naturae. Syphilis. 2 NAME. Eberly, Alison K. Edwards, Isaac L. Ellis, J. Wesley Eshelman, Emory Fegley, Amandus N. Ferguson, James E. Franklin, M. Fritsch, Herman Fritzinger, Richard J. Frink, C. S. (M.D.) Gaines, J. H. Gates, Joseph M. Gaut, Matthew B. Gemmill, Jacob M. Graham, D. M. Griffith, John H. Halbert, A. C. Hale, Morris (M.D.) Hamner, Joseph Hinton Hauna, Hugh Henderson, Henry G. Hengst, D. Alfred Hickey, Eugene H. Hill, George A. Hittell, Randolph S. Hoffman, Charles I. Hopkins, Ellwood E. Hopson, Joseph Howitt, Win. H. Huebener, Walter, A. M. Huffman, John M. Hullihen, M. F. Hunter, W. G. Irby, W. C. M. Iszard, W. H. James, H. C. Jarrett, George B. Jones, Meredith D. Jones, Robert E. Johnson, George F. Johnston, Samuel STATE OR COUNTRY, Pennsylvania. Pennsylvania. Kentucky. Pennsylvania. Pennsylvania. Michigan. Georgia. Pennsylvania. Pennsylvania. Indiana. Virginia. Minnesota. Pennsylvania. Pennsylvania. Pennsylvania. New Jersey. Mississippi. Illinois. Kentucky. Pennsylvania. Georgia. Pennsylvania. New York. Alabama. Pennsylvania. Pennsylvania. Pennsylvania. Kentucky. Canada. Pennsylvania. Missouri. West Virginia. Pennsylvania. South Carolina. New Jersey. Pennsylvania. Pennsylvania. Mississippi. Texas. Georgia. Maryland. Keller, Henry D. Pennsylvania. Kendall, Henry W. (M. D.) Illinois. Kennedy, Clempson B. Kansas. King, Wm. H. Pennsylvania. Kreitzer, John A. Pennsylvania. Landis, Henry G. Leggett, Leverett L. Levy, Charles P. Lockwood, George A. Lort, Joseph Marsh, Erasmus W. W. McAlerney, Wm. M. Pennsylvania. Ohio. Tennessee. New York. Maryland. Delaware. Pennsylvania. SUBJECT OF THESIS. Tetanus. Diagnosis. Emansio Mensium. Post-partum Hemorrhage. Death. Variola. Congenital Syphilis. Cholera Infantum. Cerebro-spinal Meningitis. Formation and Repair of Osseous Tissue. The Kidney. Animal Magnetism. Puerperal Fever. Diastaltic Diseases. Epidemic Cholera. Glycosuria. Galvanism and Faradization Thera- peutically Considered. Pneumonitis. Enteric Fever. Bromide of Potassium. Pyaemia. Opium. Diphtheria. Sporadic Dysentery. Puerperal Fever. Dental Pulp. Bilious Remittent Fever. Delirium Tremens. Laceration of the Great Omentum. Gonorrhoea. Cataract. Physiological Action of Alcohol. Enteric Fever. Anatomy and Physiology of the Stomach. Acute Peritonitis. Chorea. Scarlatina Maligna. Cholera Infantum. Scrofula or Struma. Febris Enterica. Rubeola. Uterine Fibroids. Dysenteria Acuta. Inflammation. Pneumonia. Diabetes Mellitus. Intermittent Fever. Intermittent Fever of Western Ten- nessee. Blood. Fistula in Ano. Sensorial Disorders, Labor. 3 NAME. McCandless. A. W. M. McCarthy, Samuel L. McCarty, Thos. I. McClellan, George McColly, Marst M. McDonald, G. (M. D.) McFadden, Will Gosten McGaughey, James D. Mcllwaine, R. Emmett McLean, E. P. Miller, J. Edwin Miller, J. K. Miller, John P. Minich, A. K. Mitchell, John R. Mosser, E. Neff Moss, G. W. Musser, F. M. Neely, A. F. Neff, George W., Jr. Noble, John E. Osgood, Hamilton Oxamendi, Pedro F. Parke, Benj. R. Parker, Samuel H. Parish, Wm. H. Patterson, John P. Plank, Edward H. Poley, Cyrus S. Porter, Joseph Yates Powell, James Prime, Elon G. Reeves, M. Williamson Ressler, Joel G. Robbins, Geo. R.( Jr. Russell, G. T. Rutledge, Shallus R. Schmcele, Wm. F. Schriver, Franklin Scott, John G. Senseny, Edgar N. Sharp, Samuel F. Shultz, Abner W. Smart, D. S. Smith, Albert M. Smith, Frank H. Smith, Mark L. Smith, Robert E, Snodgrass, John B. Spackman, Reuben V. Spencer, John E. Stokes, J. G. Taylor, J. Richard Taylor, S. W. STATE OR COUNTRY. Pennsylvania. Pennsylvania. Illinois. Pennsylvania. Pennsylvania. Virginia. Indiana. Tennessee. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Virginia. Pennsylvania. Pennsylvania. Pennsylvania. Kansas. Pennsylvania. Mississippi. Massachusetts. Cuba. Pennsylvania. Arkansas. Mississippi. Pennsylvania. Pennsylvania. Pennsylvania. Florida. Kentucky. Vermont. New Jersey. Pennsylvania. New Jersey. Tennessee. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Ohio. Pennsylvania. Pennsylvania. Pennsylvania. New York. New Jersey. Missouri. West Virginia. Pennsylvania. New Jersey. Illinois. Kentucky. Alabama. SUBJECT OF THESIS. Angina Pectoris. Inflammation and Ulceration of the Cervix Uteri. Placenta Praevia. Hydrocele. Gonorrhoea. Therapeutics. Romance and Reality of Medicine. Theories of Inflammation. Management and Requirements of the Sick Room. Vaccination. Enteric Fever. Inflammation. Typhoid Fever. Paresis with Cases. Gonorrhoea. Epilepsy. Typhoid Fever. Acute Lobar Pneumonitis. Bilious Remittent Fever. Inflammation. Scarlatina. Ancient and Modern Theories the Circulation of the Blood. Yellow Fever. Tracheotomy. Malarial Fever. The Sick Room. Fracture of the Skull. Rubeola. Physician and Druggist. Febris Flava. Digestion. Cophosis. Malaria and Intermittent Fever. Bronchitis. Rubeola. The Physician for the Age. Puerperal Peritonitis. Conduct of Labor. Erysipelas. Inflammation. Dysentery. Intermittent Fever. Amenorrhoea. Paraplegia. Inflammation. Mania-a-Potu. Dysentery. Hysteria. Etiology. Auscultation. Diphtheria. Abortion and Premature Labor. Pneumonia Typhoides. Hemorrhagic Malaria. of 4 NAME. Taxis, J. B. Thompson, James Trabert, J. W. Trenchard, Albert Trevino, Miguel Turpin, T. J., Jr. (M.D.) Ullom, J. T. Van Nuys, John D. Van Valzah, Frank H. Vinson, John W. Voorheis, Samuel M. Walker, James K. Watson, Lemuel Wells, Howard White, George A. White, T. H. Wick, Addison J. Wilson, Francis S. Zimmerman, G. P. Zuber, D. J. STATE OR COUNTRY. Illinois. Missouri. Pennsylvania. Pennsylvania. Mexico. Kentucky. Pennsylvania. Indiana. Pennsylvania. Georgia. Indiana. Kentucky. Missouri. Pennsylvania. California. Pennsylvania. Pennsylvania. Pennsylvania. Mississippi. SUBJECT OF THESIS. Diphtheria. Signs of Pregnancy. Hydrocephalus. Vis Medicatrix Naturae. Pathological Anatomy of the Air- Passages. Pneumonia. Infantile Convulsions. Post-partum Hemorrhage. Rubeola. Febris Intermittens. Compression of the Brain. Pleurisy. Malarious Fever. Aneurism. Haemorrhoids. Fibrin. Transmission of Hereditary Disease. The Physician. Erysipelas. Tuberculosis. Total, 162 The number of students in the Class of 1869-70 was 435, representing 39 dif- ferent States and countries.