Dr, CATLIN'S ADDRESS TO THE CANDIDATES FOR. THE DEGREE OF DOCTOR IN MEDICINE, IN THE MEDICAL INSTITUTION OF YALE COLLEGE, JANUARY lO, 1856. THE ANNUAL ADDRESS TO THE CANDIDATES FOR THE DEGREE OF DOCTOR IN MEDICINE, IN THE MEDICAL INSTITUTION OF YALE COLLEGE. JANUARY 10, 1856. BENJAMIN HOPKINS CATLIN, M. D. Vice President of the Connecticut Medical Society, , and Member of the Board of Examiners. NEW HAVEN: WILLIAM H. STANLEY, PRINTER. 1856. w )fS6 ADDRESS. The traveler as he first comes in sight of the celebrated Alps, is struck with awe and admiration, as he views moun- tains above mountains, reaching up to the clouds, presenting to all appearance an impassable barrier to his farther progress. It seems impossible that by his own powers he shall be able to ascend them ; but selecting a faithful guide, he nerves himself to the contest, and his eye fixed on the highest point, he presses on with all his energies, winding around first to the right then to the left, to avoid perpendicular and impassa- ble points, thus pursuing a circuitous course, so that, when he reaches the point which at his starting seemed to be the high- est, and is looking down upon the rough and difficult way traveled in his ascent,—he stands erect, with a feeling of satisfaction and exultation now that his task is accomplished. Not unlike the feeling of the traveler, my young friends, may be yours this evening. You have looked forward with great interest to this time when you hoped to pass a success- ful examination, and be admitted as members into an honor- able profession. I congratulate you upon having attained this standing, with honor to yourselves, and your instructors. But I return to our traveler, who, when satisfied with reviewing the difficult and dangerous ascent which he has so successfully accomplished, turns his eyes in a different di- 4 rection. Other mountain ranges, higher and more difficult, are before him, and when he reflects that he can no longer have the faithful guide who has thus far attended him, watching every step, and pointing out every danger in his course, he is depressed and, for a time, discouraged. If he has any of the true spirit of a traveler, he hesitates not long; new difficulties only excite renewed effort. This journey is renewed, with a determination never to relax his efforts till he reaches the highest point, and views the boundless prospect there presented to him. You will soon find that you have only commenced the as- cent—that the difficulties and perplexities you have already experienced are trifling, compared with those, you may en- counter, before you find yourselves established in a successful and lucrative practice; and still more, before you attain that eminence in your profession which it is your privilege and duty to reach. If you have friends to assist you, or pecuniary ability, you need not feel in haste to take upon yourselves the full respon- sibility of the practice of medicine, after receiving your di- ploma. You are still learners, and it would be well for you to be associated for a time, with some practitioner of experi- ence and ability, under whose eye you could become ac- quainted with the details of practice ; or what in some respects is more advantageous, you may spend some months or years in a hospital in some of our larger cities, where you can ac- quire experience which will be eminently useful to you through life. You will there see groups of cases which would occur singly, and perhaps but once in a life time, in ordinary practice. Having seen there, and learned there diagnosis and treatment, you will have a great advantage over your less favored brethren. But unless you are more favored with this world's goods than the majority of medical students, your funds have by this time become exhausted, and perhaps some have already anticipated their future pro- fessional earnings. 5 Sooner or later the time will come when you can no longer be under " tutors and governors," but you are to assume the character of men, and take upon you the responsibilities of men. In offering yourselves for the active duties of your profes- sion, and establishing yourselves in a successful practice, you will often feel the necessity of counsel and advice from those who have, for many years, traveled the road upon which you are about to enter, pointing out the dangers of the way, directing your steps so that you may, on the one hand, be enabled to escape those painful experiences which others have passed through, and on the other, be instructed how to obtain and enjoy the greatest amount of prosperity and hap- piness, consistent with the duties of a laborious profession. For a few days, or weeks, you will take pleasure in relaxa- tion from severe study, enjoying the society of your friends. But soon, this will become irksome, and the great question before each of you will be, how and where am I to be estab- lished in my profession ? How shall I secure and retain the favor of those who require medical attention ? It is now more than thirty years since these questions were presented to my own mind, with all their accompanying anxieties and perplexities, and they are still fresh in my recollection. It will be my endeavor this evening to give you some com- mon sense hints and suggestions which may be useful to you, if not a satisfactory answer to the above questions. Some of them may appear to you like small matters, but you should remember that life is not made up of great events, but the repetition of small, and at first view, insignificant items. Consider, I entreat you, that your success or failure in your profession will depend upon your conduct as exhibited in the common and comparatively trifling transactions of your daily life. The traveler is in no danger of rushing down into the open gulf before him, but it is the crevices 6 hid by the leaves, or perhaps covered over by the drifting snow, into which he is liable to fall unwarned. Some of you may be in the possession of wealth, or have influential friends able to provide desirable places for you, so that you congratulate yourselves upon an exemption from the trials incident to the commencement of a professional career, If any in your circle are in these circumstances, I would say to them, your case is beset with dangers of a different kind. The absence of all necessity for exertion, in most in- stances, paralizes all efforts for distinction. Those depending upon their friends, or their wealth, may soon find themselves distanced by those who, thrown upon their own resources, are compelled to untiring exertion. But should the former be able to keep off the incubus which is so liable to come upon them, and be thoroughly aroused by an honorable ambition, they will find their situation peculiarly favorable for acquir- ing distinction in their profession. They can surround them- selves with those helps which are so important to the young physician. They can procure a large library, a supply of the best instruments, and enjoy the advantages of traveling. I would say to those who feel that an early settlement is desirable or imperatively necessary, first consider what kind of a place you are fitted for by your character and pres- ent attainments. Some are better qualified for a city prac- tice, others for the village, and others still, for rough country practice. On an affair of so much consequence to yourselves, the advice of disinterested friends is always desirable. There is an appropriate sphere of action, a location, for each one of you, where you can be more useful than in any other place. I do not possess the power to direct you to that place ; direc- tion must be general—the application must depend upon yourselves. This is not the time or place, to present arguments to prove a special Providence directing and controlling the affairs of this life, leading us on in this world, as truly as " the pillar of a cloud by day," and " the pillar of fire by night," led the 7 ancient people of God through the wilderness. It is suffi- cient to say, that it is a part of my religious belief, and that the experience of many years convinces me more and more as I advance, that it is a doctrine founded upon eternal truth. The earlier this truth is fixed in your minds and hearts as a controlling principle of your lives, the more successful will you be in every worthy undertaking. You should never ex- pect to discern the leadings of Providence when you are idle. It is only when we exert ourselves, that we see the Provi- dence of God directing our steps. Difficulties and disap- pointments that we meet in the way we have marked out for ourselves, are no indication of Providence that we are not pursuing the right course. These are often sent only to try our faith. Persevere then, till you are certain you are wrong, or another more favorable opening is presented. Those who have an opportunity of filling vacancies occa- sioned by the death or removal of older physicians avoid many of the trials and perplexities experienced by others who select a place where there is no opening. If you find no actual vacancy, seek a place where there is a prospect that your services may be wanted. Under these circumstances, you must expect that your first business will be among the poor ; though it is very desirable to have the countenance and influence of some of the leading men of the place. It is well to consult such, not forgetting to call on the physicians already engaged in practice. Of course, you will not generally ex- pect much encouragement from them, but you will lose nothing by treating them with that attention to which they are entitled, by their general character and standing in the profession, as well as by their previous occupancy of the place. Your religious belief should be so firmly established upon what you believe to be the revealed truth of God as never to bend for your professional advancement; but when you are choosing a place, it is right and desirable to select one where the majority of the people among whom you expect to prac- 8 tice, possess religious views similar to your own. "While you avoid a sectarian and proselyting spirit, be decided in your religious connection, and you will obtain the respect even of those who think differently from yourselves ; while those who go from church to church, in order to gain some, will lose the confidence of all. It will be an object worthy of your attention to select a central location for your office, or place of residence, that you may readily become acquainted with a larger number of persons without seeming to make an effort for that purpose. If you board, the family where you live should be one of re- spectability and discretion, who, while they are interested in your welfare, will not injure you by their officiousness. It is very desirable that you very soon produce the impres- sion upon the minds of those with whom you become ac- quainted, that your business is the study and practice of your profession, and nothing else. This is not so easy a matter, in regard to the practice, while you have no patients to prac- tice upon. Though reading without practice is neither so agreeable or profitable, as in connection with it, still it should not at this time be neglected. This will be a favorable opportunity for adding to your knowledge of chemistry and botany, the lat- ter giving you pleasant out door exercise. A physician, after practicing six or eight years in a village, removed to one of our large cities. Here, receiving invita- tions to social parties, he declined their acceptance, giving as a reason, that he came there to practice medicine, not to visit. I cannot say that this report was strictly true of him, nor would I recommend it as a proper course to be pursued to this extent; still it was a fact, that he soon obtained a very large practice, equal in the number of his patients to that of any practitioner in the city. Many young Physicians have ruined their prospects in a place by a directly opposite course, establishing a character noted for trifling and frivolity, if nothing worse. 9 While the refining and elevating influence of good female society is of the utmost importance to young men, especially to a young physician, there is nothing more injurious to his establishment in business than light and trifling attentions to young ladies, carried to such an extent that it would seem to be the business of his life. To avoid the temptation to this course, as well as for other and more important reasons, choose early a companion of your own. Prudent young men in most of the callings of life will do well to look to their ac- count at the Savings Bank, before taking upon themselves the responsibility of a family ; but it is a matter of economy in most instances for the young physician to take a wife as soon as he has a reasonable prospect of a settlement. The speak- er can say this with truth, though he was for ten years in full country practice, without this collateral advantage. There are some conditions to this connection which should be observed, or it will become a source of embarrassment, rather than success. The very great importance of this sub- ject impels me to make some suggestions to you at this time, though I am perfectly aware that the choice of a companion is usually made in accordance with the fancy, rather than the judgment. You expect, if successful in your profession, to spend your days, from morning to evening, yea, and often from evening to morning, with the sick and suffering, listen- ing patiently to all their pains, distresses and weaknesses, till your spirit will weary at the mere mention of sickness or pain. It is wise then, so to arrange your domestic relations that your own home, as far as possible, may be the abode of health and happiness. Your own spirits, occasionally at least, will be depressed by the harrassing and perplexing cares and anxieties of your profession. The best remedy for this is a cheerful, hopeful companion, who ever has a full flow of spir- its, imparting joy and gladness to all within her influence, especially to her wearied and dispirited husband. One so dependent upon popular favor as the physician, re- 2 10 quires a large share of prudence, and it is necessary that the same character should pervade his family. I cannot say how it is in the cities. It may be that people there do not trouble themselves about the domestic relations of their physician ; but in the country and small villages, the influence of the physician's wife is great, for good or evil. You need an intelligent and intellectual companion, who can claim the respect and esteem of refined and elevated so- ciety. Or in case it should be your misfortune to be located among a people low and coarse, she might by her superior at- tainments, keep you from sinking into barbarism. Your inter- ests will be promoted by one who will be interested in your pur- suits, and can, when you are greatly pressed with business, read your periodicals, calling your attention to articles that will elucidate the cases under your care. It is not my intention to bring down this sacred relation to a matter of profit and loss, one to be entered into for your own selfish and personal interests. Without sincere af- fection, there will be no happiness, though other circumstan- ces may be in the highest degree advantageous. But I leave this subject with these few remarks, though it might be the theme of an evenings discourse. Many suppose that a practicing physician, who, if success- ful, is so universally the servant of all, having no time to call his own, can have no systematic arrangement of his business. This is a serious mistake. You will be surprised to find how, by strenuous and persevering effort, the irregular business of the practitioner can be brought into a state ap- proaching perfect order and system. The greater difficulties that are in the way, the more imperative is the demand for effort. The first business of the day should be to visit those pa- tients that require daily or more frequent visits, and they should be attended as early as they are ready to receive you. The less important and chronic cases can be deferred to 11 a later period of the day. If your patient requires a second visit, fix a time for it, and be punctual to meet the appoint- ment. Few things are more trying to the feelings of a pa- tient or his friends than to be expecting their physician, hour after hour, perhaps doubting whether he will come at all. A gentleman speaking to me of his family physician, said he always came punctually at the time appointed, unless some very important business prevented. This habit can be ac- quired by any one, and it will do much towards securing and retaining the confidence and esteem of his patients and their friends. A regular stated time for your meals is alike conducive to your health, and the interests of your business. When con- sistent with the welfare of your patients, let this be taken at your own home or boarding place. In order to accomplish this, be willing to ride a few miles farther in a day, or spend an extra hour's time ; when circumstances prevent these, and you are invited to partake of the hospitality of your friends, do it with freedom, making yourself as one of the family ; but never do it so frequently as to leave the impression that your object is to get your living out of your friends. Some part of the day, perhaps the early part of the after- noon, and a portion of the evening, can generally be devoted to attendance upon office calls. You have learned from the study of Physiology, as well as from your own observation, that man is so constituted as to require alternate seasons of activity and rest, the most im- portant being the labor of the day, and the rest of night; and you will find from painful experience that this law of our nature cannot be violated with impunity. There is a great amount of night labor performed by physicians which is en- tirely unnecessary for the sick, and could be avoided by prop- er previous arrangements. By giving plain, full and specific di- rections respecting the management of the patient and the administration of medicines, by anticipating changes likely to 12 occur, and giving directions to meet them, you can secure many nights rest for yourselves, without injury to your patient. If you are expecting changes that will require your attention, inform the friends of the patient, that he may not suffer from neglect. Next in importance to the rest of the night, is that of the Sabbath. Some physicians never seem to desire the rest of the Sabbath, but rather make it a day of unusual activity. Others, and I trust a much larger number, have a desire for its rest, but never seem to know how it can be attained. The necessary arrangement for securing the rest of 1he Sabbath cannot be made Saturday night, or Sabbath morning, but should be a subject of thought and calculation through the entire week. All visits to chronic patients can, with few ex- ceptions, be made on week days. The visits to convalescent patients, and others requiring attendance only once in two or three days, can be so arranged as to be avoided on the Sab- bath. Consultations on this day can generally be avoided. Some persons make the example of our Saviour in healing the sick on the Sabbath, exceedingly broad—broad enough to cover a multitude of sins. When we are able to heal the sick, cause the lame to walk, and restore sight to the blind, by a word, or by a touch, then we may spend the entire day in that Christ like employment. All necessary attentions to the sick we can now give as conscientiously as we can worship God in the sanctuary. If we are determined to do no other, our friends will learn our wishes, and avoid all unnecessary calls. When you are satisfied that a visit is important, or rather when you are not certain that it is unnecessary, whether it be on the Sabbath, in the night, or when you are pleasantly engaged in social intercourse with your friends, it is your duty to go, regardless of your inclinations, rest, or comfort. This may appear to be unnecessary advice to young men, who would be happy to have a professional call at any time, and under any circumstances. But young men are not always 13 attentive to business; if they are so for a series of years, they may then begin to feel that they can throw off night business and other unpleasant calls. If you are located in a city, by confining your attention to particular branches of your profession, you may do this and still retain a good busi- ness. But if you are a general practitioner, you must expect to continue attendance upon necessary calls at all times, or lose the confidence and support of the public. The habit of prompt and cheerful attention to calls will greatly promote your own happiness, and be satisfactory to the community; while a hesitating, complaining compliance, will be irksome to yourself, and disgusting to your employers. The regular, systematic arrangement of your time, wiil greatly facilitate the performance of your daily labor, and recommend you to the attention of the public. The people prefer a physician who is actively engaged in business, and will be willing, if in haste for his services, to follow him, in the morning, from pa- tient to patient; but if he never has any stated times for being at his office, or house, they will seek one who has better busi- ness arrangements. Incessant, unremitting toil is injurious to the health of the body, and exhausting to the mind, and is neither profitable to the physician or his employer. In addition to the rest of the night, and one day in seven, every physician should, if possible, leave his business at least one week, often longer, in every year. Y7ou can occasionally, by some arrangement with a neighboring physician, leave your business without detriment to yourself or your patients. Whatever tempora- ry loss or inconvenience you or your employers may suffer, will be more than compensated by your improved health and mental activity. The annual meetings of the American Med- ical Association afford favorable opportunities for these sea- sons of relaxation, giving rest from ordinary daily labors, while they are highly conducive to medical improvement. I could point you to numerous instances of medical men who, by neglecting these laws of our nature, have broken 14 down in body and mind, becoming old men, when they should have been in the prime of life. A part of every day should be devoted to professional reading. The urgency of calls will sometimes prevent this, but see that it is the exception, not the rule. You ought not to expect to retain the confi- dence and support of any community, or the respect of your professional brethren, unless you read enough to keep up with the improvements of the age. Y"ou will need one or more of the best medical publications, and every year a few of the best standard works published. If you are too poor to purchase, borrow of your neighbors. An extended business does not usually furnish an opportunity for extensive reading, but is highly favorable for much thought. As you walk or ride from patient to patient, your mind can be constantly occupied with profitable reflections upon the cases under your care, or on some subject connected with your profes- sion. Give me a physician who reads only a select number of volumes, and thinks much, rather than one who reads in- discriminately, and thinks little. Go about with every facul- ty of your mind in action, observing every thing worthy of observation, and making it a subject of serious, earnest thought. Physicians have for so long a time been accustomed to per- form a large amount of gratuitous service to the poor, that it is expected of them as a matter of course. However faithful and self-denying you may be in your efforts to relieve the sufferings of the poor, you must not expect any great commendation from the community, or even from the recip- ients of your favor, except from a few virtuous poor. But the heartfelt gratitude of these will reward you for all your labors to this class. In the early years of your practice, you will doubtless be thankful for calls of this kind ; but as you advance in life, and business of a better character comes into your hands, you should not forget the means by which you have risen to notice, but still cheerfully attend to the wants of the poor. 15 It will be expected that you will, as a sort of public man in the community, take an active and efficient part in every be- nevolent enterprise. All these calls for the exercise of benevolence should not be a matter of regret to you, to be passed over with the least possible expenditure of labor and money. Rather enter into them with all your heart, so that it may be a source of great pleasure to you instead of an irksome duty. In order to meet these calls, as well as for the purpose of securing that competency necessary for your own comfort and independence, you should commence life in the practice of strict economy. This is best accomplished by keeping an exact account of your income and expenses, always living within your means ; being ready always to practice self-de- nial, rather than to stint the mind, or the benevolent feelings of the heart. Young physicians often feel diffident about presenting their bills, fearing they may give offence, and consequently lose business. This is a false delicacy which you need never indulge. No reasonable man will complain at the proper presentation of a bill. You should in some measure comply with the business habits of the place where you are located ; but be these what they may, present every man his bill at least once a year, while many may be presented every three or six months. I can assure you, you will rather gain than lose business by such a course. It is no part of my object to commend a mere money loving spirit, but rather to encourage you to obtain the means of ac- complishing more good. If an inordinate love of money is your besetting sin, you will find little to feed it, while you keep within the legitimate sphere of your professional duties. This sin, if indulged, will lead the medical man into some form of quackery, nothing paying better when successful, though it is like a lottery ; thousands fail while one succeeds. I can hardly conceive of any other motive that would make a 16 regularly educated physician a quack, or even quackish. Some of our brethren seem greatly troubled with the quack- ery outside of the profession—the sale of nostrums in book stores, post offices and groceries. They would place them in the charge of regular apothecaries or physicians, affirming that they can be strangled in the nursery, though they usu- ally thrive more abundantly under such circumstances. Oth- ers would pass stringent laws in order to suppress all sale of such articles. If the community see fit to protect themselves in this way, there would be no objection ; but all this out- side quackery should not disturb us in the least, though we should pity poor human beings who swallow such vile com- pounds, sold at enormous profits. It is our duty to use our best-efforts to shut quackery out of the profession. Let no physician who engages in any form of it, or pockets its profits, receive the countenance and approbation of his brethren. Make it to appear, that mean, disgraceful thing it really is. Then every one who desires the respect of his brethren, or expects to succeed in his profession, will avoid all connection with quackery. Young men should take high ground on this subject, making an advance on the practice of their older brethren. The different branches of our profession require a different order of talent for their successful prosecution. Every mind may be naturally better fitted for one particular department than for others ; but as it is necessary that you should be qual- ified for all, (unless it be the more important and difficult operations of surgery, which from the nature of the case must be left to a few;) you should cultivate those faculties you find are deficient. The successful surgeon must have a sound judgment, a mechanical genius, and a steady hand. The treatment of acute diseases requires a mind at all times per- fectly ready and prompt to meet every case at once as it pre- sents itself, however threatening and appalling its character. To prepare yourselves to treat acute diseases, you should study carefully the laws of epidemics and the epidemic influ- 17 ence which has an important bearing upon all diseases. Pay particular attention to the first cases of fever, or other dis- eases, of the different seasons, and the effect of remedies, and you will soon discover the most successful course of treat- ment, so that the management of subsequent cases will be comparatively easy. One year a certain class of remedies will be particularly appropriate—another year a very differ- ent class, for a disease passing under the same name. The characters of diseases have within the last forty years greatly changed. At the commencement of the present century, ca- ses of pleurisy, requiring free bleeding every day, and some- times more frequently, were common. Now, if not less fre- quent, they are of an entirely different character, requiring a different treatment. Pneumonia of a typhoid character, requiring the free use of a stringent tonic, seems to have tak- en the place of those strong cases of pleurisy. The physician who attends to these changes and is shrewd in detecting them will be successful in the treatment of acute diseases. It is a fact which I believe will not be disputed, that more physicians fail of success in the treatment of chronic diseases and the diseases of children, than in other branches of their profession. This frequent failure leads me to make more extended remarks upon the mental and moral qualifications necessary to success in treating these diseases. Some minds may be naturally better adapted to the investigation and treat- ment of chronic diseases which may give them an advantage over their less favored, brethren ; but it is believed that nothing is required for eminent success here which is not attainable by persons of ordinary capacity. The failure is more fre- quently owing to the want of cultivation than the paucity of talent. A kind, benevolent heart, and a sympathizing spirit are indispensible requisites to success in this de- partment. These traits of character should, at all times, be apparent in the expression of your countenance, and be acted out in all your intercourse with the sick. They should see and know that the moving principle of every effort 18 in their behalf is a desire to do them good, to discover and remove their maladies, irrespective of any reward for your services. Your sympathy is not to be manifested by a long face, by drawling tones of voice, or by painting in glowing characters the distressing and dangerous nature of your pa- tients' diseases. On the contrary, you should always meet them with a cheerful countenance. Let every expression, every sound of your voice be elevating and cheering to the heart of the sick, but never treat their complaints, whether reai or imaginary, with levity or neglect Some physicians suppose they can remove all the imaginary and many of the real chronic ailments of their patients by laughter and ridicule. The only effect is to remove their patients to the care of a more rational and sympathizing practitioner. I never knew one of this character succeed in securing or retaining the confidence of chronic patients. You will find it necessary occasionally to listen attentively to a long history of your patients' sufferings, pains and dis- tresses, however trifling or imaginary they may be ; and by the manifestation of a benevolent sympathy, you may gain their confidence and lead their minds gradually to see the false estimate they make of their symptoms and enable them to partake of your own hopeful anticipations of the result- While you should by no means encourage a vain hope of re- covery in hopeless cases, you should in every case give your patients the full benefit of every hope their case will warrant. The reciprocal influence of the mind and body, in disease, is extensive and important in all diseases, especially those of a chronic nature. The influence you will be able to exert upon the mind will frequently be more important than the medicine you administer. You will find that the different states of mind which are peculiar to different diseases, render attention to this point of the greatest importance. In hope- less cases of pulmonary consumption, not complicated with other diseases, you will often be pained to witness encourage- ment from the slightest causes, or without any cause. Here 19 it will be your duty to discourage hope, for this world, while you so direct the mind and heart that there may be hope for the world to come. Many diseases of the digestive organs, which are seldom, or never fatal, greatly depress the spirits. These will give you abundant opportunity for the inculcation of hope. If you remove from your patient one feeling of despair or fear, and give in its place an encouraging hope, you have taken one step towards a cure. Follow this up day after day, and you will gradually change the whole character of his disease, and place him on the high road to a permanent cure. A most important point is gained by interesting the mind of your patients in subjects foreign to themselves, drawing off their thoughts from the contemplation of their own sufferings, to subjects of an animating and agreeable character. You will often find that this is not easily accomplished; it will require all the energies of your own mind, most diligently applied perhaps, for a long time ; but if you persevere, suc- cess will in most cases crown your efforts. Your patients will often imagine that some of their symptoms indicate a fatal termination. When you have secured their confidence, you will be able to convince them of the groundless nature of their fears ; and by allaying them you greatly mitigate their sufferings. Frequent changes of some kind are of the utmost import- ance in protracted cases—not always frequent change of med- icine, for if you prescribe judiciously, this will seldom need changing—but change of place, from one locality to another —from house to house, or from room to room; or, if this is impossible, to different parts of the room, or change in the ar- rangements of the room. It is extremely annoying to the sick to be looking for days and weeks and months, at the same objects, in one unvarying position. Any change is better than the old stereotype form. You will find this subject more fully and ably discussed by one of your able professors,jin his work entitled " Physician and Patient," in the chapter on Mind and Body in disease. 20 It always has an unfavorable influence upon the minds of the sick, to be out of their regular medicine, whether it is in itself of any importance or not. Cases will occur when you may think it advisable to lay aside all medicine for a time, but this should always be a matter of mutual understanding between yourself and patient; never should it occur through your neglect to prescribe, or procure the suitable remedies. It is perfectly natural for those suffering for a long time to become selfish—their own suffering, being, in their estimation, of more importance than all other things. Their nervous sys- tems are deranged, and they become irritable, and fortunate will be the physician who escapes his share of abuse. But however you may be assailed, however much provoked— never suffer yourself to exhibit before your patients any signs of impatience. However unreasonable the sick may be to you, always remember the precept, " in your patience possess ye your souls." If you cannot bring yourself into the habitual practice of this virtue, you had be+ter at once, give up attendance upon chronic cases. On the con- trary, if you can accustom yourself to bear patiently with all the infirmities of the sick, bodily and mental, maintain- ing at all times, and under all circumstances, a cheerful de- portment, you will commend yourself to the sick and af- flicted. You will find the importance of thorough investigation of each case in chronic disease as important as in acute. Gen- eral diseases of a serious character, and of long continuance, are often dependent upon a local cause ; while others of a local character are caused by a disordered state of the gener- al system. You will find your success in the treatment of chronic disease depending very much upon your skill in dis- cerning the proper connection between the general and local disease. Great improvements have been made in this branch of our profession, in the last few years—greater than some of my conservative brethren are willing to admit. Diseases in- curable on the old plan, have by the application of local rem- 21 edies, been readily cured. It is very natural for those who have made an important improvement in the healing art, to place a very high estimate upon it, and carry it to an unreasona- ble extent; but we should not lose the improvement in con- sequence of unwarantable pretensions. Young men, espe- cially, should examine carefully every new pretension, and if they find it is in fact an advance or improvement on old es- tablished practice, adopt it heartily and fully. Great attention has, for the last thirty years, been given to the diseases of children, and several very able volumes have been written, and a great amount of valuable informa- tion has been communicated ; still, many physicians succeed but poorly in the treatment of their diseases. This failure is not so frequently owing to a want of that knowledge which books communicate, as to an ignorance of those mental and moral influences, which it is necessary to know to enable you to investigate the diseases of children. If you have no love for children ; take no interest in study- ing their characters, habits, likes and dislikes; or if you do not understand how to communicate the interest felt in their case, you are destitute of the first and most import- ant qualification requisite for success. If your own mind and heart are right, there will be no difficulty in succeeding. It is not necessary for you to endanger the health of chil- dren by plying them with candies, raisins and cinnamon, or by gifts of any kind. You have only to feel a deep interest in children, and manifest it by kind words and actions, to se- cure their confidence and friendship. If you desire to act the hypocrite, try it upon the adult, never upon the child. Notwithstanding all the bad influence of parents often brought to bear upon their children, prejudicing them against the physician, you will, by a judicious course, make friends of all little ones ; and their friendship is indispenseble to en- able you to investigate and treat their diseases. Besides it will often give you the business of the whole family. Im- prove every opportunity as^you go from house to house, OO in the discharge of your professional duties, to become ac- quainted with the children. Learn their disposition, tastes, and habits, speak kindly and affectionately to them as you meet them, and you will gain an influence which, if rightly improved, may be the means of saving their lives. You might, for once, by deception, cheat a bitter dose into a child —seldom a second time ; but by a frank, honest course, tel- ling them the whole truth, you will seldom meet with se- rious difficulty in administering unpleasant medicine, or per- forming painful operations. A harsh and blustering manner is very offensive to 1he young; even a sharp look will frighten them. You should never stare into their faces, especially if you are a stranger; but by a kind manner and soothing tones, first acquire their confidence. It is a mistaken opinion, though prevailing in most commu- nities, and with some physicians, that it is more difficult to investigate and treat the diseases of those too young to de- scribe their sufferings, than of those who have the faculty of speech. But the diseases of the young are less complicated than those of the adult; and children are more honest in their actions than adults in their language. If you study carefully the natural actions of children in health, and those manifested in the various diseases to which they are subject, you will be so greatly facilitated in your investigation, that you will be able to prescribe with as much confidence for your little patients, as for those more advanced in life. I have had very little acquaintance with medical students for the last twenty-four years. I hope and trust, their char- acter as a class, has much improved during that time. It was once true that many commenced the study of medicine because they had failed in every other branch of business, or had nothing else to choose ; not for any love for the study or the practice of medicine. If you, my young friends, have no higher motives for entering the profession, you had better leave your diploma in the hands of our learned President. 23 Go behind the counter, into the work shop, or to the farm, or any where, or into any other honest business, rather than en- ter the medical profession. But I take it for granted, that you are about to enter it from higher and better motives. It is necessary that it should not be merely the business of your first choice, but your first love—no, I have previously pointed out what should be your first love—I may say truly, next to your God and your family, should be your profession. Aim high—be determined to be the first in your profession —seek for those honors which are to come from your profes- sional brethren, above all other worldly distinctions. These are not to be sought by intrigue or management, or any of those small and contemptible means which mean men know so well how to practice—not by endeavoring to depress others, but by elevating yourself in every honorable way ; by making those attainments which it is your duty and your privilege to make. Should you ever think the honors, in your own estimation due you, are slow in coming, be not discour- aged. Leave not the society of your brethren, nor neglect attendance upon the regular city, county, or state Medical Societies ; rather let this fact lead you to a more humble es- timate of your present attainments, and to greater efforts for future distinctions. Even though your brethren may not, for a time, duly appreciate your merits, you may rest assured they will in good time attract the attention of those whose good opinion you desire. You should pursue your profession with an enthusiasm that cannot be checked by the absence of honor, by disappointments or trials. If you can, after a life time devoted to it, so perfect your knowledge and skill as to be able to combat disease in its most appalling form, and compel any of those now deemed incurable, to yield to appropriate remedies, yon will have a reward in your own bosoms greater than any finite being can bestow. No profes- sion or pursuit in life offers a more inviting field for improve- ment than the one you have chosen. Great improvements have been made in the last half century ; much greater may be 21 expected the next fifty years. Let it be your determination to distinguish yourselves in making these improvements. You may be as useful, though not as renowned by increasing the ratio of cures in diseases now often fatal, as by discover- ing a cure for those now incurable. My young friends, our acquaintance has been brief; but short as it is, I shall, in consequence of the mere act of ad- dressing you this evening, ever feel a deep interest in your welfare, and shall watch as carefully as circumstances will permit, your course in life. I cannot ask you to regard the suggestions urged upon your attention at this time be- cause they are offered by me; but I can urge their import- ance because they are truths—and truth is ever important. If you give attention to these truths, and make that progress which it is in your power to make, I shall expect to see you mounting up the hill of science, avoiding all those pit- falls, pointed out, availing yourselves of every advantage suggested, overcoming all difficulties—mounting higher and higher, reaching one eminence after another, till you shall attain the highest elevation attainable in your beloved pro- fession. The time allotted me this evening will not permit me even to allude to many important subjects which might with great propriety receive the attention of persons in your circumstan- ces. There are thoughts of a moral and scientific character which I have purposely avoided, because they have been so ably presented by my honored brethren who have preceded me on similar occasions. I would advise you, by all means, to procure their addresses ; collected together, they will make a volume of incalculable value to you through life. Thirty years ago we had no such annual addresses ; but it was my good fortune to receive, at different times, and from several individuals among my older brethren, suggestions which have had an important influence upon my character ; and they will be remembered with gratitude, while reason and memory retain their throne. Those fathers have goiiQ to their award, but their memory still lives. 25 There is one important, moral subject that has not, as I recollect, been alluded to by my predecessors. It was first brought to my notice in connection with my professional life, soon after I left this Institution, by my venerable instructor, the late Dr. Roswell Abernethy, as pure a man as I have ever known. Speaking to me of the irregularities of a neighbor- ing physician, he said, " Above all men, the physician should be perfectly chaste." The medical man may have unusual facilities and temptations to a different course. Some have yielded, and spread a moral desolation around them, too fear- ful to contemplate with composure. No community that makes any pretension to religion, or even good morals, should for one hour tolerate the presence of a physician of this char- acter. Gentlemen, all that is necessary for you is to obey the commandment on the subject in the spiritual sense given by our Saviour, and you are safe. In conclusion, I would say, there is one more qualification necessary to complete the character of a good physician—the possession of a humble, christian spirit. In past years, we have had in Connecticut eminent physicians, who were skep- tical on the subject of religion. But however eminent they were in their day, (and I am ready to admit all their friends claim for them,) I can say with truth, they would have been better physicians, as well as better men, had they been the humble followers of the Lord Jesus. The young physician at this time is in more danger of making a hypocritical pro- fession of religion, than of embracing open infidelity. He desires to obtain the countenance and support of the religious portion of the community, and for that purpose, may unite with them, and perhaps endeavor to persuade himself that he is governed by the same spirit, while his heart may be wholly set on the world. My young friends, this is not the religion you need, as the crowning excellence of your char- acter. You want a religion that has its seat in the affections, and is acted out in your daily life and conversation. It will 26 be impossible to keep this principle alive in your heart, and to make that progress in the christian life which it is your privilege and duty to make, without attention to the means of grace—the Sabbath, the social weekly prayer meeting, the daily reading of God's word, and sincere humble prayer. I have spoken of the Sabbath as a day of rest for the physi- cal system. It is infinitely more important for the welfare of the soul. It will ordinarily be within your power to attend to all the duties referred to without neglecting the sick. To deny that your Creator, who has formed those won- derful bodies you inhabit, and your still more wonderful in- tellects, has no control over them after they have come to ma- turity, is infidelity. If you admit that He has an important and efficient influence over your mind, calling into action the dormant memory, enlightening the intellect and directing it in the contemplation of truth, you will see the duty and im- portance of seeking wisdom from above to direct you in the faithful discharge of your professional labors. You require a religion that can sustain and counsel you under the great and pressing trials you are to pass through, to prepare you to meet death in peace, and enter into that blessed immortality that awaits the righteous. Physicians have never been backward in exposing their lives in order to save those laboring under disease, however contagious and pestilential its character. The forty who fell in the discharge of their professional duty, in Norfolk and Portsmouth, the past season, were noble instances of professional fidelity. Some of those may have gone into the pestilence with the in- difference of life of the reckless soldier who marches up to the cannon's mouth. Others, we hope, had the higher kind of courage, arising from sincere trust in God, leading them to leave all with Him, anxious only to do their whole duty to God and their fellow men. You may never be called to pass through scenes so terrible as those brethren encountered; but we may reasonably expect that some of you will fall early in life. 27 It is a remarkable fact, that of the forty-five who received degrees, or were licensed in 1825, only five are known by me to have died. If we double this number, it will be a small mortality. It is perhaps more remarkable, that of all the professors actively connected with this institution, only two, the lamented Smith and Hubbard, have died. All the Med- ical Examiners of that year have been dead for years. Only one of the professors connected with this Institution in 1825, has been present at the examination just closed. Thirty-one years hence, most of us now present, shall have finished our professional course, whether good or evil, and given up our ac- count at the great tribunal. May we all apply to that Great Physician who alone has provided a remedy that can save our souls.