ADDRESS TO THE MEDICAL GRADUATES OF THE UNIVERSITY OF PENNSYLVANIA, DELIVERED APRIL 3, 1840. y BY SAMUEL JACKSON, M.D., PROFESSOR OF THE INSTITUTES OF MEDICINE IN THE TJNIVERSITT. PUBLISHED BY THE GRADUATES. PHILADELPHIA: T. K. & P. G. COLLINS, Printers, No. 1 Lodge Alley. 1840. 3 University op Pennsylvania April 3d, 1840. Professor Samdel Jackson, Dear Sir:—"We beg leave, on behalf of the graduating class, to submit to your consideration the following resolution adopted at a meeting held this after- noon. " Resolved, That a committee be appointed to tender to Professor Samuel Jack- son the grateful acknowledgments of the present class of Medical Graduates of the University of Pennsylvania, for the very appropriate, instructive and elo- quent address delivered by him this day; and respectfully to request a copy of the same for publication." In thus conveying to you the wishes of our classmates, we feel great pleasure in indulging the hope that their solicitations may not be unavailing; and that you will permit us to carry to our homes another valued memorial of a day fraught with the deepest interest to us all, and of a period memorable to us from its association with the faithful teachings of those whose eloquent counsels and inspiring zeal we hope never to forget. With sentiments of individual regard and esteem, we remain, Respectfully yours, EDWARD HARTSHORNE, WM. H. VAN BUREN, FRANCIS G. SMITH, JOHN E. LEWIS, JOHN NEILL, THOS. R. SPENCER, Committee. Philadelphia, April 4th, 1840. Gentlemen:—Your note transmitting a resolution passed at a meeting of the Class of graduates, was received this evening. The compliment paid to me on the address I had the honour to make to them, and the handsome manner in which it has been conveyed by yourselves, it would be affectation to deny, are gratifying to my feelings, and do not permit me to refuse their request. A copy of the address is placed at your disposal. Accept the assurances of my esteem, and believe me truly, &c. SAMUEL JACKSON. To E. Hartshorne, M.D. W. H. Van Buren, M.D. Francis G. Smith, M.D. John Neill, M.D. John E. Lewis, M.D. Thomas R. Spencer, M.D. ADDRESS TO THE MEDICAL GRADUATES OF THE UNIVERSITY OF PENNSYLVANIA. History, with its eras and epochs, its revolutions, changes and struggles, is the record of the events to which the opinions, the interests, and the actions of men have given birth. It is the inte- rior of man's life, revealed in things that belong to time and this world. The life of every individual, is a history, not less solemn and important. Though apparently and viewed outwardly, trivial, and often insignificant, it is eventful of most deep consequen- ces. It involves the eternal destiny of an immortal soul. It is the interior life of man, passing through the metamorphic changes of time, to come forth in a persistent form, in the endlessness of eternity. The present is an epoch in the history of your lives. You have just passed one stage: you are about to commence another. You have been engaged in the great duty of forming the cha- racter, of acquiring the knowledge, and of obtaining the requisites necessary to fit you for a profession, regarded as one of the most respected and useful in society. It involves, moreover, serious responsibilities in its exercise. The present is, then, a period for thoughtful reflection. The 1* 6 past, you are no longer masters of. It is beyond your control, and stands as evidence in favor of, or against you, according to the tenor of your conduct. Turn it now to future benefit. Reflect well on it: scrutinising it closely, and with manly firmness, look into what may have been your deficiencies, scan your errors, call forth and castigate your misdeeds. The unwhipped faults of youth, become the misdemeanours and crimes of mature life. But while you impartially weigh wherein you may have been defective, you can contemplate with self approving satisfaction, those actions, and the conduct meriting applause, deserving your own, and earning the approbation of others. The present occasion is an honourable testimony in favor of your application, your diligent pursuit of your studies, of your proficiency in your professional knowledge, and general moral worth. Without satisfactory evidence on these points, the honours of this university are not conferred. The class attending the courses of the university, the session just closed, was larger, with one or two exceptions, than in any preceding year. It was not less distinguished for its orderly demea- nor, its respectful attention to the lectures, and its general ardor in pursuit of knowledge. The candidates for the doctorate have been unusually nume- rous. They have been subjected to a more rigid and sifting exa- mination, than has been usual. This ordeal you have stood, and have acquitted yourselves to the satisfaction of the Professorial Board. You have had conferred on you the diploma of this uni- versity, the highest evidence of acquirement in the science of medicine known in this country. Though the past may present to you, as it will to all who sub- ject themselves to a proper scrutiny, much to correct and reform, yet will you find in it that of which you may be proud. Che- rish and persist in the good; repress and amend the bad. This mingling of good with ill, is the common quality of man's cha- racter. " Our virtues would be proud, if our faults whipped them not." The future is before you. How much lies buried, impenetra- ble to eye or thought, in that future! Flushed with recent suc- cess, anticipated hopes brighten the eye, and gleam upon the 7 brow. To what extent these will be realised, how little of what is promised will come to pass; how much unforeseen events and changes will blight and destroy, no prophetic eye can discern. This unknown future, it is your duty to prepare for. It flows on a vast flood of events, which cannot be stayed or turned aside. But, if we cannot master and control the events of time, we may possess ourselves of the qualifications adapting us to take advan- tage of them, as they arise. We can so conduct ourselves as to convert them into benefits, and to render them promotive of hap- piness, if not prosperity, to ourselves or others. " The fault dear Brutus is not in our stars, But in ourselves, that we are underlings." Human power cannot command and govern the exterior cir- cumstances of the world, and bend them exclusively to man's purposes. They are directed, by a divine and superior agency, to accomplish ends intended from eternity. Men are the instru- ments made use of for their accomplishment. They are endowed with the qualities fitting them for that object. If we cannot change the fixed order of exterior events and cir- cumstances, it is in our power to regulate and control ourselves, to form our principles and characters, to constitute and govern the interior circumstances of our nature. In this manner, man can adapt himself to the events that overtake and involve him. He proceeds with them, may appear to give them direction and control, for he works with them, and reaps fortune and fame: or, should he fall a victim to their overwhelming power when placed in opposition to them, he bows in submission and resignation to the irresistible destiny of a divine law. The highest ambition of any individual as it respects this world, should be, to qualify himself by a just understanding and preparation of the powers he possesses, for accomplishing some one of the infinity of ends, that can be perfected in the great movement of our social scheme, by any one generation of men. No one individual, it is probable, more than another, is selected by Divine Providence for a given end. He has provided, in the immense variety of mental, moral and physical qualifications, for the combinations necessary to form the character adapted to any especial purpose. It is always existing. The occasion and the 8 opportunity for the calling of it into action, are alone required, when it appears on the stage, in its place and time. The success of one individual more than other, in any particu- lar department of science, or line of pursuit, depends on his being always ready to seize on the opportunity and occasion, as they may offer, by which he can be introduced on the field of action, and his powers be brought into play. " There is a tide in the affairs of men, Which, taken at the flood, leads on to fortune." The difficulty that besets most men, is, either that the oppor- tunity does not present itself when they are prepared: or, when it arrives, they have neglected the preparation that is required. Opportunity once lost, is lost for ever. It seldom comes a second time. The beautiful apologue of the ten virgins, is not less applicable in a worldly, than in a religious meaning. Be like unto the wise virgins, have your lamps trimmed and your oil ready, that when the bridegroom (opportunity) cometh, you may enter in and reap the enjoyment of your foresight and pre- caution. But if, like the foolish virgins, you neglect your lamps, have no provision of oil, and when the bridegroom cometh, you have then to look after you neglected means, the door will be shut, and you will in vain seek for admission. Neglect and oblivion will be your portion. From this moment let it be a fixed determination of your minds, to devote yourselves to the fullest preparation, for the exercise of the social and professional duties that will devolve on you. A mission of more or less importance to be fulfilled in this world, is placed within the reach of every individual. It is a responsible obligation of man to his God; of the creature to the Creator, that he wilfully neglect not to execute that mission to the extent of his abilities. You have received from your instructors, in their separate valedictories, at the close of their courses, advice appropriate to each department. You are now about to separate from the Alma Mater, under whose fostering care you have been raised to your present position; and under whose auspices you enter on the world. 9 In her name, I am deputed, though it would come with more grace, and be more appropriately performed, by a higher func- tionary, to bid you farewell; and to address to you some observa- tions and admonitions, that may direct your attention, more specifically, to the duties and obligations you will be called on to perform and observe in your line of conduct. These duties may be classed under those that are professional, and those that are social. The first, or your professional obligations, are of different kinds. They may be placed under the following heads: and it is to them I shall confine my observations. 1. The obligations of forming your professional character, and of completing your professional acquirements. 2. The obligation of contributing to the advancing or perfect- ing of Medical Science. 3. The duties you will owe to your professional brethren. And, Lastly, the duties you will be called on to fulfil to your patients. A few very cursory remarks will be submitted to you on the above order of duties. I. The formation of a professional character of an elevated order, is essential to distinguished success as a practitioner of Medicine. The foundation of this character must be laid in the cultivation of a strong love of truth, of justice, and of benevolence, sustained by a profound conviction of the great truths of religion. A character into which enter these elements, must always com- mand respect and confidence: without them, no one can ever be truly great. But to these important moral qualifications must be combined, zeal and assiduity in the gaining of knowledge, of practical tact, and of experience in your profession. You have received, as the reward of your past exertions, the diploma admitting you to the doctorate. You are now to make yourselves Physicians. Do not fall into a common error in sup- posing that, with the school ends your education; that you have terminated your studies. They in fact now take a higher order, and a new direction. Your labours will increase not diminish. Courses of Lectures are not intended to complete, nor can they complete a medical education. You have been grounded in the 10 elemetary principles, and knowledge of your profession, as it exists, at the present time. You have now to make yourselves acquainted with the science, as it has been. The works of the illustrious dead of past ages; those who have left behind them a living and during memory, as observers of nature, should be perused by you. Original writers of this cha- racter are few. One or two authors in each era of the science, may constitute the extent of useful research in this respect. The great mass of writers have done little more, than repeat and comment on, the opinions and doctrines of the original few who preceded them. It is more important that you should obtain, as early as possible, practical knowledge by immediate observation. Neglect no means for this purpose. Frequent hospitals, follow the attendance of dispensaries, bestow your services on the poor, so many of whom require and gladly avail themselves of medical assistance. The principal object you should aim at, is to acquire a knowledge of disease. The symptoms alone should not engage your attention. They are the signs by which a disease is manifested: they are not the disease. What is of still more consequence, is, that you study, by close attention, the natural history of disease, the extent of the natural powers of the economy in their cure, and the methods that nature adopts, in the play of the reactive forces and operations of the system, to disembarrass it of disease. This in- formation is the most certain basis of a safe, sound and judicious treatment. It is to be acquired by the bed-side, where you must watch the progress of a case, as it traverses its different stages. and note, in writing, as they occur, the phenomena you witness. Most young practitioners mistake the proper object of their clinical studies and observations. They believe the first and great object to be attained, is the prescribing of physic. This is a vul- gar notion, cherished by the general ignorance of society as to the true nature of medical science, and the proper character of a phy- sician. It is difficult to resist the importunities of patients and friends of the sick, who expect from the administration of drugs some miraculous influences: it is difficult to divest ourselves of the belief, so flattering to self-love, that with our physic, we are omnipotent in the power of controlling the economy according to our views, and of overcoming disease. 11 The last and least important part of the science of medicine is, the dosing of patients with medicines. Understand me: do not suppose I undervalue the immense services derived from the judicious administration of medicines, in the treatment of disease. Medicines produce in the animal economy operations, such as nature is observed to excite, as the means of restoration. These processes of nature, the physician imitates; he excites them, arti- ficially, with his medicines, or other remedies. When they are done happily, at the appropriate time, and in accordance with the natural law of the disease, they prove most beneficial, and are curative in their operation. But when the medicinal opera- tion and disturbance are inopportunely provoked, when they come in conflict with the natural law of the disease tending to its solution, confusion and new disorder in the functions and organs are the consequences. The result will be to retard the recovery of the patient, to produce chronic disorders of long suffering, or destroy the power of recovery. Vel educes gwe educenda non sunt; vel augebis morbum; veljugulabis segrotum. Most physicians learn, from experience, that often their highest art consists in amusing the patient, inspiring confidence, and thereby quieting the system, that would otherwise be disturbed from nervous agitation, by some imaginary remedies, while nature is permitted undisturbed to accomplish the cure. The laws of nature are God's ordinances in the natural world. Man can do nothing without them or against them. It is the first and great object of every scientific practitioner of medicine, to study them and to master them, as they are displayed in the life- mechanism of living beings. Of these laws, it is his pride and boast, that he is the minister and interpreter. He is the servant of God, ministering to and alleviating the temporal and physical wants and infirmities of suffering humanity in the mode of his appointing; just as the ministers of our holy religion are God's servants, ministering to and watching over the spiritual failings and the endangered condition of man's soul, according to his revealed will. Medicine is a mission and a ministry, inferior only to that of religion. II. It is not less an obligation, that you should exert your powers in contributing to advance and improve the science of medicine, than it is to perfect your own knowledge. Medicine 12 regarded as an art, or a science, all are ready to acknowledge, is imperfect. That it can be advanced to a much higher degree of completeness, cannot be doubted, by any who are familiar with what medicine has been, what has been done within a few years, and what is now doing in the science. The advancement of medicine, consists in the greater accuracy and extension of its facts; with an adherence to a more rigid method of logic and reasoning. It is assuming daily more of the character of a physical and positive, and losing that of a specula- tive and metaphysical science. General theories are but little in vogue. The versatility that prevails in diseases, forbids the expectation, that any one doctrine ever can embrace conditions, so endless, diversified and fluctua- ting. Causes of a general nature, inappreciable except by the phe- nomena they produce, acting in periodical cycles of varying du- ration, exert profound modifying influences of different nature, on organised beings, more especially on the vital energies and organisation of the human race. From these result not only the great epidemics, dissimilar at each period, that prevail over whole zones of the globe, but the especial periodical constitutions that impart a common character to nearly all the diseases occurring within that cycle. A doctrine founded on the facts, as they then are observed; and a system of treatment, adapted to a particular constitution, or to a particular epidemic, may be arranged. They will be true for the time: but must fall, as that constitution, or epi- demic influence passes away, and a new revolution has brought forward a new train of morbid conditions and phenomena. In these circumstances are found the explanation of the diver- sified theories and modes of practice, that have prevailed at dif- ferent times in medicine. This has been urged as a reproach on the science and our profession. It is the consequence of things as ordained by the Creator. A theory and practice are true and applicable only for a time. A general and persistent theory is an absurdity in medicine—medical theories must be numerous and variable, for the facts, of which a theory is the aggregate expo- nent, are themselves, for the most part, complex, variable and transitive. You must not, then, wed yourselves to any theory, nor permit 13 yourselves to be enlisted as partizans to any doctrine or practice. Use your theories as a lame man does his crutches; but be ready to throw them aside, as soon as they are useless. The advance of medicine, consists in the establishment and veri- fication of facts. But what an endless labour is here opened to the profession. It extends over the whole field of organised beings, vegetable and animal, from the highest to the lowest in the scale, in their natural and diseased, or unnatural conditions. In all these are presented the phenomena of life and organisa- tion; the products of life and organisation; and the agents that influence the vital and organic phenomena in all their states. These bear with more or less force on medicine, as a science, in illustrating the complicated, obscure, and, without this collateral aid, incomprehensible phenomena of the human economy, the more especial object of medical investigation. It is to facts that alone can illustrate medical science, that you should devote your time and attention. Whatever may be the particular bent of your genius, or the kind of talent you pos- sess, there is, in medical researches, some one pursuit adapted to it. You can have no excuse for negligence. The qualifications for these objects, are industry, perseverance, application. These are in the power of each of you. They alone may enable you to establish important truths to be embodied in the science. Facts admitted into science, may be regarded as medallions struck to commemorate an event, or to perpetuate a renown. They carry to remotest time the name of their discoverers. The labour given by most men to the acquisition of wealth, ap- plied to scientific objects, would confer on you a celebrity, would make your labours useful to future generations, as to the present. To a generous mind these are far more exciting motives, than the more sordid feelings of avarice. It is unhappily true, that the active commercial spirit prevail- ing in this country and England, gives to the possessor of wealth, an undue power and influence. It represses an intellectual class; it places the moneyed interest at the head of society. A scientific and literary class, possessing a weight and power in society, is yet to be formed in this country. Our literature and science are cultivated in subserviency to the advancement of fortune. We work for money; not for truth or fame. Combat against this 2 14 feeling. To the rising generation entering into the learned pro- fessions, and to the press, must our Republic look for safety against the threatened overthrow of its constitutions, from the corrupting influence of wealth on our manners. The indignant outcry of the Roman satirist, against the venality of the Roman people, in the last days of the Republic, would appear as though extorted by a contemplation of our present state. " The first great wish that all with rapture own; The general cry to every temple known Is gold, gold, gold—and let, all gracious powers, The largest chest the Forum boasts be ours." The direction that medical investigation has taken is the ana- lysis of organic phenomena, and their reduction to the simplest possible elements. It is the second stage through which science must advance to reach its completed state. In the first period, phenomena can be known only as a unity. The reasoning founded on them is consequently erroneous. In process of time it is recognised, that the phenomena, regarded as simple, are complex. Analysis is then attempted: this is the character of medical science at the present day. It is analytical. In the last period of a science, that in which it has reached its ultimate de- velopement, the phenomena, reduced into their separate ele- ments, are reconstructed again into unity. But they are known as unity embracing diversity. Comprehended in all their rela- tions, they can then be constituted into the natural order and arrangement, in which consists a just theory. Organic phenomena, from their extraordinary complication, could not be approached by analytic processes, until the collateral sciences had reached a sufficient degree of perfection to furnish the means. This period has arrived. Organic phenomena are attacked by every method of analysis. This is exemplified in the history of organic structure. General anatomy, or the reduc- tion of the organs to tissues, commenced in our time, is now completed. The tissues themselves, are now undergoing a fur- ther reduction to simpler elements and forms. The microscope, brought to so mnch perfection, as to be free, to a great extent, from the defects that rendered it at times delusive, is an impor- tant means by which this is accomplished. The result is the crea- 15 tion of microscopic anatomy. Two great works are now issuing from the press devoted to this subject. The one, the splendid publication of Professor Berres of Vienna, " Anatomia Partium Microscopicarum Corporis Humani:,y the other, a more com- plete and equally splendid work by Professor Mandl, »f S.ras- burgh, " Analomie Microscopique.^ Besides the above large and general works, numerous contri- butions have been made by other distinguished observers, on the microscopical structure and composition of the tissues and fluids. Professor Henle of Berlin, has made a most elaborate demonstra- tion of the organization, the physiology and pathology of the mucous tissues. Erdman, Valentine, Burdach, Wagner, and others have furnished new and important facts on the elementary organisation of the nerves and muscular tissues. Time will not admit of the many examples that could be ad- duced of the new facts and new views, arising out of them, in anatomy, physiology and pathology, derived from microscopical researches in those departments. Organic chemistry is not less rich in its contributions to ana- tomy, physiology, and pathology, and will soon throw a brilliant light on the darkest spots of our science. It will not be accounted rashness, by those who have looked into this subject, when I assert, that under the searching analyti- cal review of the facts of medicine, and application of analytical philosophy to medical science, a large portion of what has been received, and is regarded as established, will be changed, or swept away. Doctrines and opinions founded on those facts, now holding sway, must disappear. They will take their place in the history of the science: they will not belong, as now, to the science. But what are we doing in this stirring and busy time, contribu- ting our aid to the improvement of our science? I fear, it must be said, almost nothing: who amongst us is at work in these new fields of scientific research, seeking imperishable fame? I fear, it must be said, no one. Three years have this day elapsed, since a young student, full of zeal and ambitious ardor in the pursuit of knowledge, stood on this stage, and received, as you have, the honored diploma of this school. He presented to the faculty as a thesis, an elaborate 16 essay, in which he confirmed Muller's discovery of lymphatic hearts, or pulsatory lymph organs, in the Batrachia, and extended it by proving their existence in other animals. He did not abandon the course he had commenced so well. He continued cultivating comparative physiology and miscroscopical investigations, though his means were but moderate. He published as a part of his labors, in the last year, an interesting series of observations on the venous circulation. He was engaged earnestly in pursuing these subjects, and but a short time since, I could have answered the question by adducing Dr. Allison as one, who promised to illustrate by his talents and industry, this department of Ameri- can science. But alas his career is ended. A few days since, and his body was consigned to the tomb. Frail in constitution and delicate in form, he fell a victim to his exertions. A wound, received in dissecting an animal, on which he was making obser- vations, was remotely, as I have been informed, the cause of his death. The war-trump, and the muffled drum, and the measured tread of armed men, and the musket shot pealing over the grave, honor the death of the soldier, the slaughterer of his brother man. But the student who meets his death battling for truth in the great arena of science, passes to an unknown grave, followed by the regrets and the tears of the few who knew his worth. Yet there is another judgment, and another reward than that of man. A brighter glory will arise from the obscure grave of the unknown student, than ever yet surrounded the blood-stained monument of the warrior of an hundred fields. You must necessarily, gentlemen, before you become deeply engaged in the absorbing occupations of the practice of your pro- fession, pass some years with much unoccupied time. Apply this to the pursuits to which I have directed your attention. The field is almost a virgin soil. You can scarcely fail to earn a bril- liant reputation, and lay the foundation for a successful profes- sional career. III. Permit me to point out a few prominent duties, that will devolve on you in your intercourse with your professional breth- ren. Much of your future comfort, and no small part of your success in your profession, will depend on the relations you main- tain with them. 17 It is impossible to avoid collision of interests or opinions, with those occupied in the same pursuits as ourselves. Society itself, is maintained in vigorous existence, by the moral actions and reactions of men on each other, acting in masses or individually. The conflicts thence arising excite our energies into activity. If governed by elevated moral principles; if a sense of truth, of justice, of honesty of intent and action, preside over our conduct, no hostile feelings are.engendered by them. In the medical profession the sources of differences in opinion, and collisions of interests, are more numerous, probably, than in any other. It is not possible that all individuals can view the very diversi- fied and incessantly varying phenomena, presented to medical observers, in the same light. It is equally true, that modes of treatment the most opposed to each other, can be made to produce the same results. There may be a choice as to one or the other, but statistical tables have not yet been formed, that would demonstrate in figures, which is to be preferred. Toleration of differences of opinion, as regards doctrine or practice, is an absolute duty imposed on every conscientious mind. Where there is difference, our duty is to examine, not to condemn and reject. No one has a right to presume that his opinions, are the stand- ard to which all others are to conform. This assumption and intolerance arising from a false pride of opinion, have been fre- quent causes of idle controversies, productive of embittered feel- ings, without deciding a single question agitated. Eschew on all occasions controversies. Truth is never elicited by them. Be always ready aud willing to enter into investigation. The more frequent cause of professional difficulties, arises out of the business of a physician. His interests are here involved, and these touch us more nearly, than the questioning of our opinions. Few occasions of this kind would exist, could man understand his true interest, in respecting the rights and interest of others? while prosecuting his own. Too often the immediate and mo- mentary gain, occupies the whole mental vision, the reactions of violated rights, of wounded interests, are overlooked. By an act 2* 18 of injustice, an enemy is made, and the confidence of others im- paired. Suspicions of unfair dealings, of trickery, of unrestrained selfishness, overshadow the character, and, from precaution or self-defence, your standing is depreciated, or the courtesies of the profession refused. I cannot, at this time, enter into the detail of the conduct you should observe, in the relations that bind you to your brethren. Every man of good sense, possessed of honourable sentiments, and a moral feeling of right and wrong, by the instinct of honesty, will know how to conduct himself, without a code to regulate his deeds. It may be permitted me, however, to speak on a few points more circumstantially for your guidance. A physician, in attendance on a patient, has a right to expect from the common courtesy that should govern a gentleman, that no other would interfere in visiting and in advising a patient, or in giving an opinion on the case; or seek, by any underhand pro- ceedings, to weaken the confidence reposed in him. Called to a consultation, if you find, on investigation, that your colleague has fully understood its nature, and had pursued a judicious treatment, sustain him in the course he has adopted. Suggest no change that is not indispensable. It might be construed into a disposition to show that you could amend, in some respects, what had been done. This course is more especially to be observed towards a younger member of the profession whose reputation is not yet established. Whatever passes in a consultation is not to be the subject of conversation to others. If consultations are to prove really use- ful, there must exist the most perfect confidence between the par- ties, leading to a full and free communication of opinions, views, and experience. But this cannot be expected, where it is known, that what occurs may be promulgated and made the subject of comment, and indiscriminate conversation. Do not suffer yourselves to give opinions respecting the judg- ment or practice of others, in any particular case, on the ex parte statement of patients or their friends. Never implicate a fellow- practitioner on such statements. They are inaccurate or false, and your opinion will certainly be incorrect and unjust. Physicians are often treated with great injustice, from capri- 19 ciousness, or other unworthy motives, by those whom they have attended. Discountenance this conduct, and sustain, as far as lies in your power, the feelings, the character, and reputation of your compeers. We cannot prevent individuals from exercising their freedom of choice in selecting their medical attendants. But we can, in all cases, take care that those who have preceded us have been treated courteously in their dismissal; that their feelings have not been outraged, and that their interest is secured. By the observance of the above rules, and the general prin- ciples pointed out, a reputation for fair and honest dealing will be formed, that must command respect and confidence. Personal differences and degrading disputes will be avoided, and the profession, by the harmony and combination of its mem- bers, will exert a powerful and a salutary influence on the moral condition of society. IV. The last order of duties to which I shall direct your atten- tion, are those that, relate to your patients. You are selected by them from confidence reposed in your knowledge, judgment and skill. Take heed that you justify that confidence. Omit no means, spare no pains to understand the case you have in hand. Investigate it closely; examine into the state of every organ and function of the body. Before you undertake to treat it with remedies, satisfy yourselves as to the seat and nature of the affection, and determine what is to be done, and what is not to be done. In chronic cases review the whole life of your patient. Let nothing escape your research. The diseases of a former time, early or later habits, the state of mind, the business, occupation, modes of living, every thing that could have exerted a perma- nent influence, are to be brought into review. In acute cases attended with danger, be assiduous, even to overwatching, in your attentions. In doubtful periods make your visits, for your own satisfaction, more frequently than may be actually necessary. But do not, in that case, burthen your patients with charges for them. When life is in great danger, and depending on your skill, remain with your patient until the event is decided. The intercourse of a physician with his patient, must be of the 20 most confidential nature. There are occasions when it is neces- sary that the mind should unburthen its inmost thoughts, and the heart pour forth its hidden secrets. That which is of deeper interest than life itself, must be confided to the physician. But for this the most implicit reliance must be placed in his secrecy, his integrity and honour. Make it a rule to speak of your patients, their affairs, their families, their diseases, with the greatest reserve. In referring, as may be sometimes necessary, to their cases, do not mention names. The patient must feel assured that the physician is a depository, in whose bosom every trust is sacredly preserved. One of the most delicate offices the physician is called on to perform, is the communication of a fatal termination to a dis- ease. The inevitable result is known to him, in many cases, long before it is suspected by the patient or his friends. Your opinion will be looked to with anxious solicitude. Never delibe- rately deceive. According to the circumstances, be more or less explicit in giving your judgment to the friends and to the patient. You cannot always be frank and open, expressing in the clearest manner your convictions on these occasions. When you find it necessary, prepare gradually the mind for the reception of the truth; but never buoy up with false hopes you know must be disappointed. To many persons, from a happy temperament, or a more happy preparation of the mind, sustained by elevated principles of religion, death presents no terrors. They rise above the weaknesses of common natures. To them death comes as a friendly messenger, surrounded with beautiful attributes, to an- nounce the change from time to eternity; it is a blessed harbinger, summoning to a brighter and holier existence, in the eternal com- munion of the virtuous and the just, with their Creator. With such you need have no concealment. There are others, again, whom the thought of death over- comes with dread, and sinks in despair. A premature commu- nication would prove disastrous. Provident nature has not been neglectful in this our greatest need. A period arrives in the fail- ing of the powers of the system, when life is felt as a burthen, and the soul, yearning for its native and eternal home, longs to escape from its corporal thraldom. The most timid no longer 21 dread it. Though but of late, the mind refused to contemplate it as a thing too fearful to be looked on, it is now welcomed with pleasure, and sought for as a relief. Wait with such, until you perceive this state approaching. Your tidings, then, will not be of sorrow, but of great joy. Many other topics might be introduced and expatiated on. They must be left to your own judgments and discretion, which, fortified and directed by sound principles, will not fail to suggest an appropriate conduct as circumstances may require. The connection, gentlemen, that has subsisted between you and this Institution, now ceases. You pass from under its foster- ing protection, to wend your way in the devious paths of life, guided by the principles you have here imbibed. The interest you have excited in us, will not cease. Success and renown in your profession, reflect honor on your instruction and your school. Failure and disgrace tarnish their reputation. Take with you our blessing: and believe us most sincere in our wishes for your happiness and prosperity. Go forth on your great mission; and, in its successful performance, reaping golden opinions from your fellow-men, may you be hailed in their grate- ful aspirations, " the hands of heaven." In the name of my colleagues and myself: in the name of your Alma Mater, I bid you farewell.