Valedictory Address, 
Delivered April 2, 1883, 
By J. M. DA COSTA, M.D. T II E 
HIGHER PROFESSIONAL LIFE: 
VALEDICTORY ADDRESS 
TO THE 
GRADUATING CLASS OF JEFFERSON MEDICAL COLLEGE, 
PHILADELPHIA, 
Delivered April 2, 1883, 
By J. M. DA COSTA, M.D, 
PROFESSOR OF THE PRACTICE OF MEDICINE. 
PHILADELPHIA: 
J. B. LIPPINCOTT & CO. 
18 83. THE HIGHER PROFESSIONAL LIFE. 
Pleasant faces, warm wishes, greet you on every side. 
Every one in this brilliant assembly is overflowing with 
kindly feelings. Mothers, sisters, brothers, friends, are 
joyously vying with one another to make the day one of 
gratification to you. As the representative of the Faculty 
for this hour, can I do otherwise than catch the tone of 
prevailing sentiment ? May not one of us, after months 
of labor in common, assure you, truthfully for all, gladly 
for himself, that we congratulate you with all our hearts, 
and that we share with those nearest to you the pleasure 
that the honors you coveted have been won ? 
On an occasion like the present it is regarded as ob- 
ligatory to say something as a parting word in the way 
of counsel and general advice. Instead of adhering to 
this custom, I shall offer you a few remarks on the kind 
of life you have chosen, and on the higher life which full 
success demands of you. The diploma just placed in your 
hands has made each of you a Doctor of Medicine, sin- 
gula jura, honores, et privilegia. What these rights and 
privileges are you are soon to realize, and, unless I am 
much mistaken, you are all quite willing to realize them 
with the least possible delay. But I am not going to 
speak to you of rights and privileges, or of the popular 
notions of a physician's vocation, but of what it really 
is, as known to those who lead it. Certainly it is not 
3 4 
THE HIGHER PROFESSIONAL LIFE. 
an easy pursuit. It is a life of constant hard work, of 
many anxieties. To those who patiently wait for their 
chance in large cities, and to whom gradually success 
conies, there conies also with that success an amount of 
labor which makes them strangers to their own firesides 
and their own children. We all have our trials, no 
matter how placed. Interference, silly suggestion, blame, 
calumny, preference given to the shallow pretender, are 
the least of these, and the most easily borne. But who 
credits us with the awful responsibilities? Who takes 
into account the struggle of our failures ? Who thinks 
of the wear on our sympathies ? Who knows the humble 
toil, the physical labor, the mental strain, of him whose 
name may be in every mouth in a metropolis ? 
And the life of that most deserving and most hardly 
worked of any of us, the country practitioner, what is it 
but toil, toil, especially if his field of work be some 
sparsely-settled portion of the country ? In " The Sur- 
geon's Daughter," Sir Walter Scott tells us that he 
heard the celebrated traveller Mungo Park, who had 
been a country medical practitioner, give the preference 
to travelling as a discoverer in Africa to wandering in 
his former capacity by day and by night in the wilds of 
his native land. He mentioned having ridden forty 
miles, sat up all night, and successfully assisted a woman 
under the influence of the primitive curse, for which his 
sole remuneration was a draught of buttermilk and a 
roasted potato. There are many' parts of our country 
where similar things are daily happening. The enor- 
mous distances, the terrible roads, the lonely rides, the 
exposure in all weathers, the going back at any hour, 
at the call of every one, over long paths just traversed,- 
these make up much of the life of many a country prac- 
titioner. I declare I hold them to be true heroes, when THE HIGHER PROFESSIONAL LIFE. 
5 
I regard their hard existence, their pure pathetic lives; 
when I recall their cheerfulness and manliness; when 
I see them, generously forgetful of self, answering every 
call with alacrity; when I think of the warm heart that 
beats so steadfastly under the fuzzy damp coat; when 
I know that the lantern that guides them in a dark night 
to the house of distress is but like their own calm pur- 
pose and resolve shining forth to guide and comfort 
others. 
But this is the hard side of the life you have chosen. 
The bright side is very bright. To be the welcome vis- 
itor; the one to whom all turn in trouble, and to whom 
family secrets are confided with the freest faith that they 
will be sacredly guarded; to be eagerly sought in hours 
of danger and of anguish and feel that you have the 
power of relieving; to be the hope of many, the friend 
of all,-this surely makes a splendid calling. And to be 
benevolent and charitable beyond those of most other vo- 
cations; to become imbued with the feeling that to refuse 
to relieve suffering is a disgrace; to be taught by the very 
exercise of daily pursuits the virtues which make men 
great and good,-these certainly are benefits for which 
you must thank Providence, that has led you into so 
useful and worthy a life. 
One decided compensation for much discomfort is 
speedily ours : knowledge of the world comes to us quickly. 
We soon become philosophers. Shams have fewer attrac- 
tions for us: we are too much behind the scenes to be 
much impressed with the pageantry of life. We learn to see 
men and women as they are ; and we appreciate how much 
more evenly the gifts of Heaven are distributed than the 
superficial observer thinks. Nature is just, not generous. 
My lady who rolls past in her carriage with her little 
blanketed pet dog on the cushion alongside, making indo- 6 
THE HIGHER PROFESSIONAL LIFE. 
lence the occupation of her life, grows fat and puffy, is a 
prey to nervousness, and passes restless nights. The washer- 
woman, who works hard, sleeps well. The head of a great 
banking-house, his shoulders bowed with the weight of 
millions, anxiously leads his sedentary life, is apt to eat 
largely of food which his weakened nervous energies will 
not let him digest, and learns to envy the hardy son of 
toil, who gets up with the birds, labors in the open air all 
day, and has the digestive powers of an ostrich. No! 
Fortune is not the partial jade she is represented to be. 
How often do we see that 
1 She either gives a stomach, and no food,- 
Such are the poor, in health ; or else a feast, 
And takes away the stomach,-such are the rich, 
That have abundance, and enjoy it not I"-2 Henry ZTr., iv. 4. 
But it is not my intention to speak to you solely of 
what the physician's life brings with it in its cares, its sor- 
rows, its pleasures, its compensations. I know that you 
will experience them all. I take it for granted that you 
will reach the success which industry and perseverance 
are sure to attain ; that you will become devoutly thankful 
for a life which keeps you away from many temptations, 
and affords the freest scope to your highest moral quali- 
ties; that, in short, every one before me will become the 
busy, the popular, the good, the beloved doctor in his 
community. But, this accomplished, is it to be all ? Is it 
to be the summit of all endeavor ? No ; the time will come 
when, should you aim at nothing more, the intellectual 
side of your nature will starve. There must be some- 
thing beyond; there must be other attempts, if you are 
to feel that as a man you have taken a man's part in life. 
The secret of happy life lies in belief. The secret of 
all great success in life lies in aspiration. All higher THE HIGHER PROFESSIONAL LIFE. 
7 
life is constant aspiration: in morals, for the true and 
good ; in literature, for the elevating and instructive; in 
art, for the beautiful; in science, for the unknown. The 
thing to be dreaded in professional life is that we grad- 
ually become more and more incrusted with commonplace. 
There is but one way of avoiding this, and the mental 
wasting that follows it,-to have aspiration beyond our 
immediate pursuits. This may be of more than one kind, 
according to tastes, opportunities, natural gifts. 
To most of us, perhaps, the easiest and most congenial 
way of interesting ourselves in problems which are com- 
paratively unsolved, and which we approach with the 
desire of adding something to existing knowledge, lies 
in the close study of what we come across in our daily 
employment, in grouping the results, in analyzing them, 
in endeavoring to discover the general law which binds 
isolated facts together. To those attached to public insti- 
tutions it is comparatively easy to engage in this kind 
of study, as well as a duty, for large opportunities con- 
stitute an obligation and a trust. But even for those who 
are merely concerned with the every-day occupations of 
professional life there are ample chances. Is there not, 
for instance, still a great deal to be learned of the first 
beginnings of disease, of the very points, therefore, which 
the family physician has the best means of studying ? The 
way in which hereditary affections are modified through 
the agencies acting in our multiple and changing society 
is another fruitful subject of inquiry. Still another is the 
development of new diseases, or of new types of diseases, 
by different states of civilization, and by new industries 
springing up, and the manner in which special climates 
on this great continent influence constitutional taints as 
well as the ordinary chronic maladies. Here are prob- 
lems which any thinker with the opportunities, and they 8 
THE HIGHER PROFESSIONAL LIFE. 
are constantly presenting themselves to all, can aid in 
elucidating. 
There are other fields of science in which original in- 
quiry gives great results, and to which those specially 
gifted with abilities for experiment may turn. Not to 
speak simply of the solution of physiological questions; 
or of observations in the sciences linked to medicine, as 
botany or comparative anatomy; or of the valuable re- 
searches which are adding year by year to our knowl- 
edge of remedies, there are those splendid provinces of 
thought and experiment which have made the names of 
Darwin and Pasteur immortal. Take Darwin, absorbed 
in but one idea, by combined hypothesis and experiment 
to make Nature reveal the laws of her secret working; 
now spending years in watching the minutest processes 
of animal life, now devising the most ingenious experi- 
ments, now launching forth broad generalizations, which, 
whether we agree with them or not, have started fresh 
thoughts in the minds of all thinkers. Look at the 
wonderful labors of Pasteur. See France, in alarm at 
the threatened extinction of her silk-culture, turning to 
her son of genius, and witness the wonderful sagacity with 
which he detected the cause in organisms coming from 
without the silk-worm; found, by experiment, how to 
render them innocuous; and in so doing not only revived 
the languishing industry of his country and saved her 
untold millions, but also laid the foundation of a system 
of research into the causes of disease in man and in the 
higher animals, which has already resulted in many a 
glorious triumph as regards prevention, which has led in 
his hands to rendering the fatal splenic fever of sheep 
and cattle almost innocuous and to putting a stop to the 
cholera of fowls, and which promises to give us the long- 
sought-for antidote for hydrophobia. Think of the wide THE HIGHER PROFESSIONAL LIFE. 
9 
applicability these researches and the "culture experi- 
ments" may be found to have in ascertaining the true 
cause and means of prevention of scarlet fever and of 
other acute specific diseases. Take the last great dis- 
covery in this line, that of Koch, of the minute germs 
found in consumption. Look at all these great results, 
-and they are but the forerunners of others as great, 
-and you see some of the benefits of experimental in- 
quiry ; and perhaps an idea may also be formed of the 
keen delight it must have been to work out these con- 
clusions. It is true that favoring fortune in the one case, 
and the enlightened liberality of government in the others, 
supplied the means for that leisure which is necessary to 
sustained and productive research. It is true also that 
few of us are Darwins, Pasteurs, or Kochs. But we can 
all humbly imitate them in smaller ways, and share with 
them some of the pleasure which such investigations give. 
It may be helpful, it is not essential, to dwell in great cen- 
tres to take part in this kind of work. It is not necessary 
for the highest success in anything to be surrounded by 
multitudes. The London of Queen Elizabeth numbered 
only one hundred and sixty thousand inhabitants, but it 
produced Bacon and Shakespeare. Jenner was a country 
practitioner, full of the spirit of investigation, and it is to 
his love of it that you and I are perhaps indebted for our 
lives; and in consequence of his great discovery, that I 
can look around on hundreds of charming faces unseamed 
by the scars of smallpox. 
Yes, Science will make her home wherever she is wel- 
come. She will gladly come to your hearth if you cherish 
her. And I behold her among you the source of much 
happiness. I picture to myself the home of some of you 
where she has made a settlement; and I see a modest 
country-house becoming famous as another garden-spot in 10 
THE HIGHER PROFESSIONAL LIFE. 
the world of ideas. There is certainly much happiness in 
scientific aims, though they can be carried out only during 
leisure hours. There is an absence of the bitter struggles 
of those who live only for greed. And then there is the 
beauty of an ever-widening horizon. It is in science as in 
nature. As the wanderer leaves the level ground, new 
ranges of hills, new streams, new forests, are seen. The 
ascent continues; the crags are loftier, the golden lights 
more golden, the shadows deeper. Still higher, a gorgeous 
panorama is before him ; at his feet lie grassy fields, path- 
less woods, and outstretched lakes, around him are splendid 
mountain-tops, gilded by the sun. As he looks keenly, 
more and more come into view. Everywhere 
" Hills peep o'er hills, and Alps on Alps arise." 
Nor is the mental vision of the trained investigator 
limited to the obvious facts the eye and ear discern. His 
mind goes beyond them, and has noble conceptions of 
great truths. His eye gazes into the unseen with a singu- 
lar clearness of sight; echoes from the world of knowledge 
beyond reach his ear; he catches the sound of the waves 
as they break on the shores of the distant, undiscern- 
ible sea. 
In our profession it is most likely that the scientific 
investigation of nature will, in one form or other, be the 
predominant pursuit to which men aiming at higher 
studies will turn. But even among us there are those 
for whom literature has greater attractions than science, 
and who will devote themselves to it in all their leisure 
hours. I am not speaking of purely professional litera- 
ture ; for to keep ourselves acquainted with the additions 
to existing knowledge is, I hold, part of our sacred duty 
to our patients. I mean general literature. It is fas- 
cinating, but in our profession it is unfortunate if its THE HIGHER PROFESSIONAL LIFE. 
11 
pursuit stifle the love and pursuit of science. Yet I am 
far from thinking that general literature should be neg- 
lected. Nay, I maintain that attention to it has a much 
higher value than to make merely men of charm and of 
general knowledge. I think that the cultivation of the 
humane letters has the most distinct bearing on the cul-. 
tivation and appreciation of science. Science is nothing 
without imagination; and imagination is most readily 
kept fresh by literature. What little good is there in 
a mere descriptive person, and in the small facts which 
with painful toil he accumulates. But let these facts 
be welded together by thought, their bearing traced by 
imagination, experiments devised by the mind project- 
ing itself in advance of them, and the plodder is likely to 
become the great discoverer. True, the solution of the 
problem may be different from what was first imagined; 
yet it is on one of the paths traced by imagination 
that the hidden evidence will be found. And to him 
who has kept his imagination alive, and in whom con- 
stant exercise strengthens the powers of observation, the 
recognition of the truth comes more and more speedily,- 
it becomes almost an instinct. 
But there are other uses of the cultivation of literature 
to the man of science. He can become the disseminator 
of truths in a manner which is otherwise denied him. 
He can make himself understood, and the influence of 
what lie has to say felt, as none but a man of culture can. 
The world will not stop to fathom obscure meanings, but 
it likes to be instructed, if the instruction come in plain 
language and with some grace of expression. It is not 
moved to take an interest through colorless thoughts, or, 
to use Cicero's telling words, tenui quodam exsanguine 
sermone, in topics discussed in tame and bloodless phra- 
seology. Above all, it will not be a patient listener if all 12 
THE HIGHER PROFESSIONAL LIFE. 
you know, however valuable, is flung at it at once. It 
resents the intrusion and flings it back. Let us always 
be mindful of Bacon's wise saying, " If you have a hand- 
ful of truths, open but one finger at a time." 
There are many other sides to the advantage of liter- 
ary culture to the professional man which might be dwelt 
upon. But to consider them would lead me too far away. 
Only one more will be mentioned,-the pleasure, the rest 
it is. What change of thought, what repose, the love 
of literature bringsI What delight in forming lasting, 
loving associations with the best minds! what satisfac- 
tion in keeping company with pleasing, with great ideas! 
No wonder reading may become absorbing. It may 
become a passion, as it was with Cervantes, who tells us 
himself that it led him to reading even the torn bits of 
printed paper in the streets. 
But there are other sources of exertion for those aim- 
ing at a higher professional life than the cultivation of 
science or of literature. There is the chance, which to 
some will prove the most attractive, and the most to their 
taste, of mixing in the great movements which are to bene- 
fit mankind, and of making their influence felt in them. 
Can there be, to him who likes to work on men, a finer pur- 
suit than to interest himself in promoting temperance? 
Who knows better than a physician what miseries intem- 
perance entails? Who oftener sees the wrecked house- 
holds, the broken lives, the physical evils, caused by it ? 
I take up a recent English journal, and find that a most 
efficient committee, appointed to inquire into the mortality 
referable to alcohol, reports a long list of its ravages, among 
them a fourfold increase in the deaths from diseases of 
the liver and chylopoetic viscera, a twofold increase from 
disease of the kidney. I look at the last report of the 
Pennsylvania Hospital, and see that in its Insane Depart- THE HIGHER PROFESSIONAL LIFE. 
18 
ment, out of eight thousand six hundred and seventy- 
three cases, eight hundred and sixty-three were due to 
this curse, only one cause on the list, " ill health of vari- 
ous kinds," exceeding it. What a field, then, for phil- 
anthropic exertion, and what a field also for personal 
influence 1 
Then there is that highest expression of the develop- 
ment of modern medical science, sanitation and preventive 
medicine. What greater work for any one than to busy 
himself in this? What interest in a community higher 
than to avert disease and death ? 
The profession of medicine, with the manifold opportu- 
nities it has of observing mankind, on a small scale and a 
large scale, in all its moods and needs, and with the laws 
of nature it sees at work, ought to be far more than it is 
the profession of great movements. Here is one in which 
it can take the most vivid interest and exert the greatest 
power. Let me not be misunderstood. I know it is im- 
possible for the individual doctor immersed in his daily 
work to become an active sanitarian in particular direc- 
tions. For this there must be special officers, whom the 
community should liberally remunerate and encourage. 
But any one can identify himself with this movement of 
preserving health and life; we can all help it along and 
give direction to it by guiding popular thought. We can 
all aid in bringing nearer the great future to which pre- 
ventive medicine must lead. 
Of course people must be first made to see sanitation 
in its importance. Nothing is ever accomplished with- 
out something of the spirit of the fanatic; and it is needed 
here. It is difficult to arouse full concern in this matter; 
it is difficult to contend with the surging forces of special 
interests; it is difficult to penetrate the deep ignorance 
which attends the subject. One of the greatest obstacles 14 
THE HIGHER PROFESSIONAL LIFE. 
is to make every one understand that pure water, pure 
air, general cleanliness, the prevention of decomposition, 
the stamping out of the germs of disease, affect him and 
his individually. Neglect to attend to all this is always 
thought of as acting only upon our neighbors, and as 
proving disastrous to them, not to us. La Rochefoucauld's 
well-known maxim, that we all have strength enough to 
bear the misfortunes of others, receives nowhere a better 
illustration than here. Appeals to mere self-interest may 
have weight with those in whom the spirit of the shopkeeper 
is stronger than that of good citizenship. Tell them some 
of the facts you know. Point out to them that it has been 
calculated by the English Board of Health that the failure 
to prevent the deaths and serious illness due to preventable 
diseases entails on England annually a direct loss of ninety- 
six millions of dollars,-more than the interest on her pub- 
lic debt. Show them that the Commission appointed at the 
instance of Congress to investigate the epidemic of yellow 
fever in New Orleans reckons the losses to the city for one 
year at upwards of fifteen millions ; and that a competent 
authority, in a paper in the Reports of the American Pub- 
lic Health Association for 1880, from which I have quoted 
some of these facts, estimates that this same epidemic re- 
sulted in a loss to the part of the country it attacked 
of fully two hundred millions, a sum nearly equal to one- 
third of our annual exports; point also to the blight that 
has befallen Memphis; to the manner in which the springs 
of industry are dried up when smallpox prevails in our 
large cities, and how business shuns them, and self-in- 
terest alone is likely to make zealous sanitarians. 
Then in sanitation, as in every other great movement, 
we encounter those who can see no use for change in any- 
thing. Did not their ancestors live and flourish in full 
ignorance of sanitary precautions ? why should not they ? THE HIGHER PROFESSIONAL LIFE. 
15 
There they are, ready to defend everything that has always 
existed; to assert that to attack any evil is to trifle with 
the groundwork of society. 
Bat ignorance is still the greatest drawback to the spread 
of sanitation and preventive medicine. Even among the 
educated a kind of good-natured indifference is found in 
place of desire for knowledge. It is, perhaps, the igno- 
rance and general indifference which are responsible for 
the obtuse state of mind and the lack of appreciation of 
their work, which are not rarely found among those whose 
duty it is to enforce the law. That such, unfortunately, 
exist cannot be denied. Thus, I read the other day that 
not long ago in a neighboring city, before a legislative 
committee, a health inspector-who had been, however, a 
keeper of a grog-shop-was asked, " What will best pre- 
vent smallpox ?" and answered, " Coffee; burnt in the 
room." And a colleague of his, when questioned as to what 
the branch which he was supposed specially to understand, 
hygiene, is, replied, " A mist arising from low grounds." 
You smile. But there are persons of all kinds, in offi- 
cial life as well as out of it. There is greatness in every- 
thing. There are fools so great that, like the great folks 
Thackeray speaks of, one has a mild shock of awe and 
tremor whenever one looks at them. 
But neither the ignorance nor the indifference will last. 
The great body of the people in all civilized lands is 
being touched with friendly interest. It is beginning to 
seek information, and to look to us for it. Our duty is 
to have the knowledge and to give it. It is a. remark of 
Matthew Arnold's, that on mankind in the mass a move- 
ment, once started, is apt to impose itself by routine. The 
movement has begun, routine will continue it. And you 
must be in the van, enlightening, pleading. There are 
diseases of which the cause is unknown. Providence has 16 
THE HIGHER PROFESSIONAL LIFE. 
not yet allowed us to fathom it. They cannot be pre- 
vented by anything; they must still remain. But there 
are numbers of which the cause has been ascertained, and 
which could be wholly done away with or be reduced to 
narrow limits. Who, then, is responsible for their exist- 
ence ? A narrow public sentiment which begrudges the 
cost of their extermination, which will furnish nothing 
for the most useful investigations; the supine authorities 
who make no adequate exertion, and who turn a deaf ear 
to the voice of science and of humanity. There is in 
this matter a terrible responsibility somewhere. To allow 
a single life to be sacrificed that would have been saved 
by more thoughtful arrangements and by making use of 
what the science of the day has clearly established, is 
cruel and criminal. It is not carelessness, but murder. 
Plead,, then, in season and out of season. You are not 
urging the solution of a problem, but care for human 
lives. Plead for the helpless infant whose blood is being 
tainted by the pollutions decomposing in a July sun. 
Plead for the struggling worker on whom a subtle influ- 
ence has fastened, weakening his energies, and making 
the support of those dear to him a harder and harder, 
an almost impossible task. Plead for the woman whose 
children one by one have suffocated before her eyes from 
the terrible poison of diphtheria. Plead for the father 
who sees the pride of his household, the darling of his 
old age, die a miserable death from typhoid fever. Plead, 
and you will have at your back the haggard mother with 
her childless, outstretched arms grasping now wildly noth- 
ing but the air; the strong man bowed with grief whose 
heart is dead. Plead with all your might. Plead, plead ! 
your voice is but the echo of the voice of sorrow ; you are 
only asking in sorrow's name for justice. 
There are thus many ways in which the aspirations of THE HIGHER PROFESSIONAL LIFE. 
17 
a higher professional life may be realized in useful or 
in great work. Some of these can be followed actively 
only when success has brought comparative leisure; but all 
can be kept in mind; one or all can be aimed at through- 
out our careers and according to our individual strength. 
In so doing we shall live a life full of interest, a life of 
noble pursuits. 
" We live in deeds, not years ; in thoughts, not breaths; 
In feelings, not in figures on a dial. 
We should count time by heart-throbs. He most lives 
Who thinks most-feels the noblest-acts the best." 
But, friends, the hour has come at which we must part. 
The past, with its quiet traditions, is to give way to the 
future, with its stirring action. The hands are moving 
on the dial towards the completed hour, marking for the 
last time the minutes for us in common; and these few 
moments are all that separate our joint narrow endeavors 
from the larger life which is to be all your own. Let it 
be your own in the same spirit in which in long bygone 
years, at the end also of their period of probation, the 
aspiring youth received with the solemn investure the 
tokens of knighthood. The golden spurs and the sword 
were simply the outer signs of their dignity. The manly 
sentiments, the sense of honor, the courtesy, the desire 
for heroic enterprises, the valor, the loyalty, were the real 
qualifications to be jealously guarded through life. There 
are no Lancelots, no Rolands, no Sidneys, no Bayards, 
now. But the sense of chivalry is the same ; only in our 
times its spirit is even higher. In place of wild adventure 
it seeks that which is most generally helpful to mankind. 
Soyez preux, hardi et loyal was the exhortation with which 
knighthood was conferred. Also, " Be a good knight in 
the name of God." So may it be to each of you! Be 18 
THE HIGHER PROFESSIONAL LIFE. 
brave in the unfaltering discharge of duty and in con- 
stancy to the right; be bold in search of truth and in its 
enunciation; be loyal to your profession, your comrades, 
and your College. Sound, trumpets, sound ! "Be brave, 
bold, and loyal!" " Be a good knight in the name of 
God!"