From the N. H. Journal of Medicine. 
AN ADDRESS TO THE GRADUATES OF THE 
N. H. MEDICAL INSTITUTION, 
At the Medical Commencement, JVov., 1853. 
BY JOHN E. TYLER, M. D. 
Gentlemen of the Graduating’ Class :— * 
You have now spent the 
time required of you in preparatory study. You have pass- 
ed an examination creditably to your teachers and to your- 
selves, and you will receive the diploma of this venerable 
and excellent College. You will shortly have attained to 
what has for so long a time been a prominent subject of 
your thoughts and the burden of your desires. You will 
very soon be real Doctors. And now you are to put on the 
harness of professional life, (and a straight harness it is,) and 
work for the relief of suffering men, women and children. 
You will no longer enjoy the careless freedom, the luxury of 
a mere student’s life. You will leave this quiet town, whose 
very atmosphere is conducive to study, and makes one feel 
wise. You will leave this famed and honored College, to 
which it has been your privilege and pleasure to resort,— 
famed and honored for the triumphs in medicine and surgery 
here achieved,—famed and honored for the wisdom and abil- 
ity of its past and pre.sent teachers,—honored and gratefully 
remembered by the many all over the world, who have here 
laid the foundation of a successful and useful life. But, 
think not as you leave here, professional men, that you have 
“ completed yobr studies,” as the phrase goes. Think not 2 
that books may now be laid aside, and that you already 
possess all the intellectual materials necessary for the suc- 
cessful practice of medicine. The examination you have 
passed, and the degree you will receive will work in you no 
special miracle, will confer upon you no mysterious and 
hitherto unpossessed power. You will find that though 
Doctors, you are the same men that you were twenty-fours 
ago, only twenty-four hours older, and with a little longer 
name. You have just commenced, not completed, your 
studies. The hardest, far the hardest is to come ; the battle 
of life is before you ; and with a Doctor, ’tis an every day 
fight to the end,—and study, careful and continued; thought, 
steady and severe, with labor unremitting, can alone give 
you the victory you desire. 
Although we have it on good authority that “ there is 
nothing new untler the sun,” still things under the sun 
have been so whirled about, shaken up and turned over since 
“ the life and times of Solomon,” that the world to-day is 
at any rate, different from what it ever has been before, 
Every body is restless and impatient for results. Rapidity 
recklessness, and energy,—I had almost said fury,—charac- 
terize every moment. Steam whirls us about with frightful 
and dangerous swiftness, and yet is getting to be considered 
quite too slow. Ten days is far too long for crossing the 
Atlantic; it must be done in five, even if to do so we are to 
be propelled by ether and by fires suggestive of the Pit. 
Nothing slower than lightning is fit to transmit news, and 
dry goods must be instantaneously puffed through miles ol 
iron tube; and a man taking yonder railroad car to-morrow 
morning will see and hear more things, will live longer in 
one day, than did Methuselah in his nine hundred and sixty 
and nine years. People are impatient of everything, even 
of the length of life, of which the daily fearful and melan- 
choly multiplication of suicides is testimony. In religion, 
people are impatient, and will not hear long sermons or long 
prayers, be they ever so eloquent or ever so fervent. In 
physic, men are impatient, and demand a cure of their ail- 
ment at a specified time, with the same ct/H and confident 3 
expectation that they require the punctual making of a coat 
or completion of a contract, and men choose to drink Cro- 
ton oil at a risk, and have the business through with, rather 
than lose time with the more amiable and quiet work of its 
cousin Castor. If a man breaks his leg or his head, it must 
be mended by a certain day, and if he has not a straighter 
and a handsomer leg than ever nature meant for him, or if 
he fails now of an eminently wise head, though all his life 
he’s been a ninny, he’ll sue the Doctor and mulct him in 
damages enough to support him like a prince. Although 
diseases change somewhat from year to year, so as to re- 
quire a modified treatment, and the physical condition of 
man is somewhat modified by the spirit of the age, still the 
great facts and truths of disease and its progress remain the 
same. Broken bones require as much time as ever to knit 
together. Typhoid fever will have its run, and ulcers will 
not heal one day sooner for all the hurry and impatience of 
their owners. These facts of the times, however, affect the 
physician, and range prominently under the head of diffi- 
culties in the present practice of medicine. It is the duty 
of the physician to answer all the demands made upon him, 
which are not impossible. Those which are he must not 
pretend to answer. To do this, is clearly and purely the 
province of the quack. 
You have chosen for yourselves, gentlemen, a laborious 
profession, and you should enter it with the expectation of 
a laborious life, a life with its hours of intense excitement, 
when days and weeks are crowded into minutes of time, a 
life with hours of gloom and deep anxiety, but with hours, 
also, of clear, genuine happiness and joy. If I speak to you 
chiefly of its trials, it is not because it has no bright side. It 
has, indeed, its many trials, but it has, too, its rich and abun- 
dant rewards. And if you would reap the latter, you must 
inevitably undergo the former. You should, then, enter the 
profession with a determination to perform all its duties, and 
to shrink from none of its difficulties, trials or fatigue. You 
must be ready at all times, in all sorts of weather, and un- 
der all circumstances, to promptly and cheerfully answer all 4 
demands for your services. Let a call, by day and by night, 
in sunshine and in storm, by the rich and by the poor, by 
the civil and the uncivil, all appear to others to be the same 
to you. 
Attend strictly to your professional duties, and hold inci- 
dental business, politics and pleasure, entirely secondary. 
Always be at your post, or have it distinctly known where 
you can be found. You had better be out of the way when 
a friend would induce you a gunning, than to be gunning 
when a patient requires your attention. It is not a slight 
matter for you to have a reputation of always being atten- 
tive to your business. 
To succeed in practice you must have and hold the confi- 
dence of your patients and their friends, and to secure this 
you must have a quiet, modest, but evident confidence in 
yourselves,—not the growth of a conceit that you know ev- 
erything, and can account for everything, but that genuine, 
unobtrusive confidence in yourself which naturally arises 
from the possession of knowledge and the consciousness of 
ability. You must ever be adding to your stock of knowl- 
edge by study and observation and reflection, and you must 
come to know your own ability and increase it by improving 
all opportunities for its exercise. Therefore, be determined 
to do ivhatever you are called upon to do, and do it in the 
very best and most thorough manner. You may at first 
meet with many duties from which you will instinctively 
shrink, many things which you will not know exactly how 
to do, and which you will not feel certain you can do, and 
you will be greatly inclined to call for aid from some more 
experienced brother. Learn here, then, a lesson of self-reli- 
ance. “ What man has done man may do,” and you un- 
doubtedly may do, and will be certain to do, and do well, if 
you have a strong will thereto. The only way for you to 
acquire skill is by your own practice, by personally doing 
each and every duty of a physician, and neglecting none. 
You must meet every difficulty with a firm, brave heart, and 
be determined to conquer. Rely on yourselves. Let nothing 
ever escape you through doubts of your ability, or a dread 5 
of undertaking an untried task. “ Whatsoever your hand 
findeth to do, do it, with all your mighty 
Before long, gentlemen, each of you doubtless will have 
decided upon a location for yourselves, and will have made 
arrangements for the practice of your profession. It is hard 
tp commence practice. There are troubles and trials at the 
onset which are hard, very hard to bear. You cannot avoid 
them, but you will learn to bear them. There are hours of 
suffering, yea, of torture, gloomy, wretched hours, in store 
for the young physician, and they doubtless will be yours, 
but you will survive them, and be better for their discipline. 
’Twill seem hard to you if you have to wait for days, and 
may be for weeks, for a call for your services, and many, 
many a young Doctor has to do it, and it will be harder if 
you have a call at once. Sooner or later, however, you will 
make your first professional visit. You will see that nota- 
ble and ever to be remembered person,—your first patient.— 
If you are faithful, if you are determined to begin right, if 
you feel that interest in your patient and in your reputation 
which you ought, there will be many things in your first case 
to puzzle you, and if it be a serious one, which will give 
you a world of anxiety, and rob you of your sleep. To-see 
a patient with your preceptor, to hear him enumerate symp- 
tom after symptom, as he at once discovers them, and from 
practice arranges them, and determines therefrom so easily 
the pathological state and treatment required, may have 
seemed to you the simplest and most natural and comforta- 
ble process in the world, easier, no doubt, and more natural 
than to him. But to call on your first patient alone, to as- 
certain yourself where the trouble is, and where all the 
trouble is, and what it is, to make up your mind just what, 
and just how much to prescribe, to bear this new responsi- 
bility ; to feel that a life, and with it the condition and com- 
fort of a family, depends on you; to feel that your profes- 
sional reputation and success is at hazard,—is not so easy 
and comfortable, and then to tell the friends the name of the 
disorder, and its probable result, and to inform the kind 
neighbor by the door, who has seen a great many Doctors, 6 
and who has “just stepped in ” when the new Doctor came, 
when, and where, and how, and why,—’t is not so easy, or 
natural, or so comfortable after all. These latter are minor 
things, but they are not trifles. Then, after having settled 
in your mind what the condition of your patient is, and 
having prescribed to your own satisfaction, you go home and 
consult your books, and may be you find there many symp- 
toms given which you have not noticed in your patient, and 
you are certain you have noticed some symptoms which are 
not given in the books, and you begin to question whether 
you have not mistaken the case, whether, after all, what you 
have considered and prescribed for as pleurisy, may not be a 
disease of the heart, or whether the headache which you 
have decided to be the result of a disordered stomach, may 
not be an indication of brain fever, or the rapid pulse which 
suggested to you inflammation, and on account of which 
you depleted, did not betoken debility, and require stimu- 
lants ; and so you may be worried and troubled, and get 
preciously confused. Others have been thus troubled before 
you. But you may leave your patient, satisfied with the 
correctness of your diagnosis and your prescription, and 
upon careful review and comparison with authorities, be 
confirmed therein, and yet at your next visit find your pa- 
tient in every respect worse. You will doubt your own 
abilities in the premises, and mistrust that some one else 
might have produced a different state of things, when in 
truth you have done far better than an older and less careful 
man. It may fortify you to know that others have felt just 
so. And again, your patient, though quite sick, may be 
getting on well, and you are conscious of doing all for him 
that man can do, and are feeling satisfied with the progress 
of the case. Still, from some unaccountable cause the 
friends may get uneasy, and on your next visit you will see 
that you are not met quite so cordially as common, and your 
patient’s answer to your kind greeting is, “ I’m no better, 
Doctor,” and as you make your customary examination, sev- 
eral more of the family than is usual or necessary leave their 
work and come and soberly stand about the bed. You do 7 
not find the patient worse, but there’s something wrong. 
Your questions are all answered, but nothing more. Ques- 
tions are not asked in the usual free manner, nor is the ordi- 
nary glib little history of particulars volunteered. You are 
chilled by the silence, and feel annoyed by the want of con- 
fidence in you, and the “ experienced nurse,” as she steps 
very much in your way to do something for the patient en- 
tirely unnecessary, ominously and oracularly remarks that 
“ he is a very sick man.” You know that something is on 
their minds,” that something has been talked of and decided 
on before you came in. Do not be surprised or too much 
grieved if it is nothing worse than that it is thought best 
that an older Doctor be called into consult. Do not object 
to this, or appear averse to it. Cheerfully accede, however 
little you may like it. All this has happened to others, and 
they have survived it. It is better usually to anticipate such 
a proposition. When you perceive that there is a little un- 
easiness felt, (and if you are sensitive you will discover it 
very quickly,) it is best to speak first yourself. You can 
very composedly and indifferently say, “ I see that you are 
feeling very anxious about this person, and he is indeed very 
sick, but there is nothing obscure or very difficult to manage 
in the case, still, if you have any wish to call in counsel, do 
not hesitate on my account.” In nine cases out of ten after 
such a move, you will be left to go on quietly and alone. 
Such is human nature. In really serious cases it will gen- 
erally be for your advantage to seek counsel. Your first 
cases, whatever they may be, if of any severity, will neces- 
sarily distress you. You must expect it, and make up your 
minds to endure it, for anxiety, perplexity and trial, more 
than this, real unmitigated, undiluted misery seem to be an 
inseparable and unavoidable part of a physician’s early ex- 
perience, a necessary preface to his life, a sort of purgatory 
to be passed before the paradise of confidence can be 
reached. 
I well recollect my first patient. He was a stout youth, 
and came to my office and said he was sick, and I believed 
him. From his account of himself, and from his answers to 8 
my many questions, you might suppose he had any one of 
a great number of diseases. He had lost his appetite and 
his legs ached, his bowels were sore and his head ached. 
His tongue was furred, he had a cough, and he felt cold and 
hot, and a great many other ways. What in the world was 
his real ailment was a mystery to me, and I was not certain 
but he had the seeds of something dreadful in him. Two 
facts, however, were clear in his case. He had caught cold 
and was costive, and I reasoned upon these until I ventured 
to order him a sweat, and a brisk dose of calomel, aloes and 
jalap. I thought a great deal of that boy that night, and 
wondered what would become of him, but to my surprise 
and great relief, he was alive and well the next day, and 
gave me no further trouble, for he has n’t been sick since. 
And my next patient, to whom I made my first profes- 
sional visit. How well I remember her ? With what care I 
studied and re-studied her symptoms. How constantly, too 
constantly, I attended her. How often did I make some 
slight change in her medicine, and direct some new applica- 
tion for her relief ? With what eagerness did I watch for 
some slight sign of amendment, and with what agony of de- 
sire did I hope to see some trifling good for my remedies, 
and in my disappointment, how uncertain was I that I was 
doing right. How uncertain what to do. How fearful that 
I was doing harm, that I had mistaken her disease, and that 
through my error she was growing worse. There was not 
one bright spot in the whole case. My first visit was a pain- 
ful one to me, and so were all that followed. All that I did 
was utterly without avail. She died, and with her all my 
hopes. If a similar experience be yours, it may be a drop 
of comfort for you to know that you are not the first who 
has thus suffered. Be not disheartened. Brighter days will 
come ; however laborious your whole professional life may 
be, the first part will be the hardest part to bear. 
It is essential to your success, gentlemen, that you com- 
mence practice in a way that shall secure to you correct pro- 
fessional habits, correct habits of observation, of thought, of 
study, correct manners and conduct. Be careful, minute 9 
and thorough in the examination of your first and every 
succeeding case. Gather all the information from every 
source at your command, from the appearance of the tongue, 
the state of the pulse and skin, the expression of the coun- 
tenance, the hue of the complexion, the character of secre- 
tions and excretions, from such manipulations and examin- 
ations as may satisfy you of the condition of the viscera, 
and by such questions as shall show to you the feelings and 
sensations of body and mind, the previous general habits 
and state of health, the occupation, and what exposure there 
may have been to the weather, disease or fatigue. From 
these data, carefully considered and compared, deduce your 
diagnosis. If you cannot do it in five minutes, take ten. 
Deliberately conclude upon the pathological state of the 
person, and then prescribe those medicines which you judge 
will best accomplish your purposes. Never allow yourself 
to prescribe at random, or for a disease by its name; for in- 
stance, never prescribe for a headache, a sensation, but for 
what makes a headache, something material and within the 
province of doses. But endeavor, always, to satisfy your- 
self just what and how much disease you have to deal with, 
decide upon what results you wish to produce, and use the 
means which you have learned will produce them; for it is 
easier not to think than to think, and without a strong reso- 
lution at first and continued, to be correct in this particular, 
a habit will insidiously possess you, destructive to all scien- 
tific practice. If your case perplex you, if symptoms seem 
to conflict, and you are unable to satisfy yourself of the 
exact condition of things, proceed cautiously, in accordance 
with the most probable view of the case, and,'like Mr. Mi- 
cawber, wait for something to turn up. Attention, study 
and reflection will in a little time set you right. Let me 
repeat it, always have a definite object in prescribing,—a 
good reason for your prescriptions. Correctness here is vital 
to your being anything but a mere artisan in medicine. If 
this be difficult at first, it will by practice become easier, and 
at length gain over you and for you all the force of an in- 
valuable habit. 10 
And herein will your books come to your aid. You 
should consult them carefully and systematically. Study 
out your cases in your office slowly and deliberately. Read 
and reflect on the matter you have in hand, and not only 
that particular phase of the disease in your patient, but 
upon all its phases and attendant circumstances, consider its 
mode of attack, progress and termination, its management 
and treatment, and do this until all is ineffaceably imprinted 
upon your memory; and when you have other cases of the 
same disease, pass all carefully in review, and as you receive 
new books and periodicals, post from them every thing you 
think valuable under its appropriate head, and so keep on 
unflinching and untiring through months and years, and you 
certainly must become well informed and scientific men, 
whose counsel will be valuable and sought for, and whose 
opinion will be authority. In your reading, seek for the 
practical rather than -the theoretical. Lend your ear the 
closest to the men who know whereof they write, “ who 
speak what they do know, and testify of what they have 
seen,” and not only of what they have once seen, but re- 
peatedly, and have settled for truth by years of experience. 
Stick to the authorities in medicine, for those things are least 
liable to disappoint you which in the hands of intelligent 
and skilful men have for years proved to be reliable. The 
shades of disease are so diverse, and the attendant and mod- 
ifying circumstances so many and so powerful, that you will 
find the firmest authorities none too firm for you to depend 
upon. In most cases a majority of probabilities must decide 
you. Sulphur will cure the itch, that is beyond dispute; 
but opium will not always make a man sleep, nor antimony 
make him puke, but they almost always will, and therefore 
you will not hesitate often to use them for these purposes. 
You should take some of the Reviews and Journals of the 
day, if for no other purpose than to be familiar with what 
is transpiring in the medical world, but be cautious of re- 
ceiving them as authority, although captivating theories may 
be advanced and brilliant successes vaunted. An old but 
good maxim will apply well here, “ Believe only what seems 11 
reasonable.” Try every thing first in the crucible of com- 
mon sense, and then test by cautious practice, and whatever 
proves valuable, gladly receive. 
But be not too conservative. There are old fogies in 
medicine as well as otherwheres. Cling not to an old thing 
simply because it be old, it may be dead, nor reject a new 
thing because it be new. Follow not a course sanctioned 
by the schools, if, after due consideration and fair trial, you 
are not convinced it is right, simply because it is a “ regular 
thing,” only do you be sure to sufficiently distrust your own 
judgment when it clashes with the dictum of many wise 
and able men who give authority to “ regular things.” 
Search after truth always. Search after that which will in 
the readiest and best way alleviate human suffering, and 
wherever you may find the truth, no matter in whose pos- 
session, no matter how ignoble its surroundings, so it really 
be truth, seize upon it and make it your own. The veriest 
quack may have a truly good remedy, and on it depend all 
his fame, albeit he knows no more of its modus medendi 
than a mule does of exegesis. Do not waste yourself in 
fretting about it, or in saying that the good is bad, but 
quietly get possession of it, and if it be true gold, it will 
pass as currently from your hands as from his, and far more 
respectably. If you know that o a grain °f Belladonna 
will affect the brain, and relieve the headache better than | 
of a grain, and that a shadow of a dose of chamomile will 
quiet a child better than paregoric; if you know that a cold 
wet towel will relieve a sore throat, and that a dose of the 
“ anti-spasmodic tincture” will snap a fit of hysterics quicker 
than assafcetida or antimony; if you know these things, do 
not be deterred from their use because Homeopathists and 
Hydropathists and Thompsonians so use them. Do not refuse 
a truly good thing, just because its birth has been accounted 
doubtful. But do not be too fond of looking for truth in 
such places. ’Tis searching for jewels in swines’ snouts. 
In the practice of your profession, gentlemen, life and 
health are not to be the only objects of your care. It will 
be your duty to consult as much as possible the comfort of 12 
the sick, and that physician will be the most successful, the 
most sought for, and the most beloved, who does the most 
to place his patients, both bodily and mentally, in a condi- 
tion agreeable to themselves, and conducive to their ulti- 
mate recovery. Any fear you may remove, any uneasiness 
you may relieve, any disquiet you may soothe, will be appre- 
ciated quickly by the sick, and for this, medicine is not al- 
ways necessary; a cheerful countenance, a kind word, a 
confident tone, or a well timed story, are often more avail- 
ing. Seem not over anxious for your patients, for you will 
thus surely arouse their anxiety, and that of their attend- 
ants, and injure both yourself and them : but on the other 
hand, never appear careless or indifferent. Make them sen- 
sible that you feel a strong interest in them, and that you 
are moved by an earnest and heartfelt desire to relieve their 
suffering and promote their welfare. 
Let this desire to give comfort to others, to do them real 
substantial service, and all the service you can, control your 
whole conduct. You can easily disturb a whole family and 
make them many steps for your own convenience, after a 
cold, bad ride. You can in muddy times track across a 
newly washed floor, and by coarse and boisterous language 
show your independence and oddity. You can produce a 
sensation by curious and sarcastic questions, or by severe 
and ill-timed jokes. But it is not wise. However well 
you may prescribe, and however successfully your prescrip- 
tions may result, it is doubtful whether by such a course you 
do not in the aggregate give a family more trouble than 
comfort; better be quiet and gentle and civil. Some dis- 
tinguished physicians have been very rough, odd men, have 
said and done rude and odd things, but they became great 
in spite of their oddities, and not by them, and would have 
been greater men, would have won more hearts, would have 
given more comfort, and have caused a more affectionate re- 
membrance of themselves, without them. I know a physi- 
cian well, a thorough and accurate scholar, and a remarka- 
bly excellent and successful practitioner, who is very rough 
and odd, and who has told me that he prided himself on his 13 
manner, on being Abernethy-like, and that he got practice 
by it. But the truth is that his practice would be doubled 
were he a civil and a courteous man. 
You will not often be professionally called when your 
presence is not necessary, or supposed to be so. Some in- 
convenience is felt or imagined which you are expected to 
remove. Be sure that you do remove it, no matter if it be 
insignificant. Never be so rude as to laugh or fret at one’s 
folly in unnecessarily calling you. People in this world had 
rather be considered wicked than foolish, even in little things, 
and you can easily wound their pride and cause a prejudice 
against yourself. Endeavor always to leave those who have 
sent for you, feeling in some respect the better for your visit. 
Cultivate and exhibit every where the kindness, courtesy and 
firmness of manner belonging to the true gentleman. 
Pay proper regard to your dress. Avoid a slovenly appear- 
ance or practice, and on the other hand, be not so nice that 
people will fear to approach within a given distance of you. 
Be slower to speak than to hear. Most people had rather 
hear themselves talk than any one else, and the fact of your 
being a good listener will with many give you a better rep- 
utation than the utterance of the most profound wisdom. 
As a general thing, the less you have to say about the con- 
dition, symptoms and prospects of your patients, even to 
their friends, the better, and never, for the sake of explana- 
tion, or of satisfying them of your knowledge of the case, 
give them a medical lecture. They will not appreciate it, 
and you may commit yourself to something which in the 
end will prove untrue, and shame if not injure you; where- 
as, for silence you can seldom be sorry. When you have a 
patient in danger or a doubtful condition, and find the 
friends extremely anxious and fearful of the result, you will 
be very liable to give them a word of encouragement which 
you do not feel yourself. Guard against this carefully. 
Never encourage a patient to keep them quiet, unless you 
have grounds to do it. Never say, “ he is better,” or, “ I 
think he will get better,” if you do not really believe it. If 
you do this, results will make you belie yourself, and you 14 
will impair the confidence of people in your judgment or 
prognosis. You are responsible for the correct and proper 
treatment of your patients, and not for the result, and you 
are not to feel that because a case results unfavorably, you 
of necessity mismanaged it. People will die in spite of the 
best of treatment and in spite of your closest attentions, 
and if you, without reason, allow yourself to feel that you 
are blameable for it, you will show it, and the community 
will soon be of your opinion and also blame you. 
Your profession will admit you to the privacy of families, 
will lead you even to the most retired chambers, “ will cause 
you to behold the human character disrobed, by the rude 
hands of mental and corporeal suffering, of all the coloring 
and drapery thrown round it by the forms of society, and 
thus make you the depository of facts which involve the 
happiness of individuals and of society.” Be true to your 
trust. Never reveal even to your closest friends, what your 
professional position alone permits you to know. And fur- 
ther, say nothing of the trifling things you see and hear.— 
Do not tell Mrs. A— what Mrs. B— remarked or what she 
had for dinner. Gossip not at all. Never allow yourself to 
make fun of or show up a patient’s condition for the amuse- 
ment of his neighbors. Should you do this in unimportant 
instances, people will quickly infer that you may trifle and 
jest at and expose more serious matters, and so you may 
lose their respect and confidence, and form for yourself a rude 
and despicable habit. 
You will find it particularly necessary, gentlemen, to have 
your temper under control, for many and severe will be the 
trials thereof in the practice of medicine. You will meet 
with many annoyances which you must patiently and good 
naturedly bear. You will be at the mercy of garrulous old 
ladies, and jaundiced Betties of your own sex, who will 
seize upon the new Doctor and insist, (when you are in a 
hurry or wishing to study,) upon telling you minutely of 
their numberless diseases and peculiar sensations, of their 
unparalleled sufferings, of the quantity and diversity of the 
doses they have drank, of their interviews with Doctors, and 15 
the astonishing remarks they have made, and what miracles 
of obstinacy their ailments have been. They will have your 
opinion upon divers points in their economy and pathology, 
and insist on your prescribing again and again for them. 
You must bear these dispensations of Providence as best 
you can. 
You will be greatly tried by the whims and caprices and 
unjust exactions of the sick and their officious relatives. 
You will be censured for tardiness in answering a call, when 
your delay was clearly unavoidable. “ You will be too ear- 
ly or too late. You will visit too often or not often enough. 
You will give wrong medicines, or in wrong doses. You 
will bleed when a sweat would answer. You will give a 
dreadful dose of calomel when a cataplasm was needed.” 
You will do different from the old Doctor, or just like him, 
and in either case be wrong. Your patient recovers. It is 
no thanks to you, Oh no, he had a wonderful constitution! 
Or, he dies. You certainly put him through. Under such 
trials as these, gentlemen, keep your temper and hope for 
better things. 
You will be tried by the meddling of neighbors, who dis- 
trust the young Doctor, and advise a change, or who despise 
doctors and their doses, and commend McAllister’s ointment 
and a famous “ family pill.” You will be tried by the va- 
rious forms of quackery, and, perhaps, by the quacks them- 
selves. Never stop to quarrel with them. Let them entire- 
ly alone. They thrive by opposition and will die by neg- 
lect. The most arrant will occasionally make a good hit, 
and if you deny it, you will only injure yourself. But if 
you must occasionally encounter the friends of some famous 
herb woman, or seventh son, or medical Indian, do it not 
“ with a fierce or passionate tone, nor in the language of vi- 
tuperation or abuse, for thus you will strengthen their old 
opinions, or fix them, if wavering, and convince them that 
self-interest and not philanthropy, is the cause of their hos- 
tility. But your true and effectual plan will be, with all 
moderation of tone and manner, to appeal to their common 
sense in the matter, to demonstrate the absurdity of quack- 16 
ery in general, and of the particular form in question, and 
to show clearly the immense amount of evil which flows 
therefrom.” 
You will be tried by the inadvertencies, and, I grieve to 
say it, by the positive offences of your medical brethren. 
Some old Doctor may remark at one of your neighbor’s, that 
no doubt you are a very fine young man and intend to do 
right, but that you have n’t had experience, or he acciden- 
tally may be passing the residence of one of your patients 
and be called in. He looks about seriously and silently, and 
“ does 7i,t know ” but all is going on right, it is delicate for 
him to say anything. The medicine is shown him, and he 
indifferently asks if the patient is troubled so and so after 
taking it, and nods. 
You may lose a patient, and some kind brother hopes it 
was no fault of yours, but remarks that such cases are not 
ordinarily difficult to treat. Many, many are the wounds 
which one practitioner may inflict upon another, and you 
may not escape. But for your own part, however much 
you may desire practice, desire honor more. Always and 
strictly observe professional etiquette, “ those rules which 
the wisdom and experience of our predecessors have estab- 
lished for the regulation of our intercourse with one another 
and the community.” They are in conformity with the 
nicest principles of honor. Adhere to these, however much 
your fellows may sin against you. Like the Great Physi- 
cian, “ when you are reviled, revile not again.” But those 
of whom I have just spoken are not numerous in our pro- 
fession. The brotherhood to which we welcome you to-day 
is composed in the main of high minded and honorable 
men, men devoted to the advancement of science, and to 
the best interests of humanity, true men, in whom you may 
safely and implicitly confide. 
Allow me, gentlemen, to allude to one other matter, which 
you may not neglect. You will not long be unmindful that 
by your profession you must earn your bread. You should, 
therefore, have its business part systematically arranged. 
You should have a set time for making your daily charges, 17 
say at night, and days, at regular intervals, for posting your 
books, and from these fixed times you will not often find it 
necessary to vary. Compel yourselves to this practice, (I 
mean, of course, when you have anything to charge,) until it 
becomes with you a settled habit. Once in three, or six 
months, at least, draw off all your accounts and present a 
bill to every person in your debt, and give them civilly to 
understand that you expect it to be paid. In this way you 
may offend some who have been accustomed to years of in* 
dulgence from their former physicians, but as soon as it is 
known to be your regular way of doing with every one, 
there will be no complaint; and thus you will avoid the diffi- 
culty and danger of wrangling over an old and half forgot- 
ten account, and the possible inconvenience to your debtor 
of a demand illy proportioned to the condition of his wal- 
let, and by so doing you will collect a large proportion of 
your charges. 
And here let me say what I believe to be of great impor- 
tance to you in other than a pecuniary point. Charge for 
your services, reasonably to be sure, but charge for all neces- 
sary visits and medicines, and make out your bills to the Jull 
amount. Then if from the circumstances of your patient, 
you see fit to make an abatement, let it be understood and 
appear to be a deduction made for a specific reason. In the 
estimation of the public, now a days, “ what costs nothing 
is nothing worth,” and you may be sure, if you charge but 
half price for what you do, you will be esteemed according- 
ly. You may have been unsuccessful in a case. Either af- 
ter a longer or shorter period of attendance it may have been 
transferred to another, or the patient may have died. You 
may even feel that although conscious of having done your 
best in the premises, your services have really been of little 
account, and you will feel disposed to reduce your demand 
greatly below a real compensation to yourself. Now never 
under such circumstances present a bill below what is a rea- 
sonable equivalent, not for results given, but for duties done, 
unless you are willing to admit that you have done wrong, 
and a reduction will be considered an admission thereof, al- 18 
beit a word to that effect is not said. Charge the full and 
righteous amount due, and although there may be present 
grumbling, you will be the more respected and the more likely 
to be again called upon by the same people than if you 
cheapen yourself. 
I do not mean to say that you may never give your ser- 
vices freely, or without the formality of reduced bill. Nay, 
there will be many occasions when you will wish in the 
clear charity of your heart, to receive no pecuniary reward 
for your most careful and constant attentions, and when in 
the most unostentatious way, you may decline all remuner- 
ation with propriety and honor to yourself. 
In closing, let me urge you, gentlemen, to strive by close 
and critical study of books, and by constant and untiring 
attention to the details of practice, to deserve and possess 
the reputation of thorough scholars and skilful physicians, 
for this is an object worthy of your ambition. Strive, also, 
by honest and honorable means, for the accumulation of 
property, for this is necessary and not to be despised. But 
before and above these and all other things, remember al- 
ways that you are immortal and accountable men, account- 
able to God. Never for a moment forget it, and let the 
thought qualify all your actions, and be the spirit of your 
life. Remember always that the present passing moments 
are your life, and that your thoughts and acts therein, these 
items of your account, are posted in the great ledger of eter- 
nity, and will meet you again. There is nothing in the 
practice of Medicine to render a man skeptical, but every 
thing-, every day, otherwise. Every thing to make him, if 
he will, know and feel the constant presence of a Being of 
infinite wisdom and Almighty Power, and every thing, ev- 
ery day, to make him wish to depend on such an One, and 
cast his cares and burdens there. To a man who views life 
rightly, to a really religious man, the profession of Medicine 
offers opportunities for doing good, beside the relief of phy- 
sical Suffering, unequalled in any other profession or any 
other business. A physician has access to persons whom 
no one else can reach, and at times when no other one would 19 
be allowed, at times when the feelings are tender, when the 
conscience is aroused, when persons, whether they will or 
no, must and do reflect. He is privileged with an intimacy 
allowed to no other, and receives, if he is what he ought to 
be, an unreserve of confidence given to no friend, however 
near and highly prized. He sees men at times when he may 
say to them what no other man may say. He often stands 
in such a relation to men that a word from him may change 
the whole purposes and character of their after life. The 
proud scoffer upon his sick bed does not think it humbling 
to confess to his physician that he trembles with the fear of 
death, or to crave from him a prayer. The dissipated man 
will own his folly and pledge his faith alone to hirn. The 
reckless, the gay, the wayward, will listen to him, and be 
moved by his words as they can be by no other man’s words. 
May he lightly meet these occasions? May he neglect or 
misuse such power for good ? These responsibilities you 
are about to assume. Do it not lightly. Rely on God and 
consecrate all your energies to the work of doing good. Do 
it always and ever, and look for your reward beyond this 
life.