I
ADDRESS
TO THE
            ON





   THE PRESENT DECLINE





           OF THE






  MEDICAL CHARACTER,





           AND THE





      MEANS OF ADVANCING






PROFESSIONAL RESPECTABILITY.
 
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V 
I
I
ADDRESS.
 To my Professional Brethren of Philadelphia.
     Gentlemen,
  The  natural interest every generous indivi-
dual must take in any  measure calculated to
advance or secure the credit of his profession,
will, 1 am persuaded, justify a well meant effort
to serve that to which  I am attached. That it is
quitting the eminence it lately held, is a melan-
choly truth our fondest desires cannot conceal,
and  it becomes us to inquire into the cause of
this unfortunate change, to ascertain whether or
not,  it  depends on circumstances  under  our
control, and if possible, devise some  plan to
prevent its farther declension.
  The  great and  extensive benefit of the heal-
ing  art, the  necessary qualifications,  and vast
responsibility of the  physician,  entitle the pro-
fession  to  the rank  assigned to it by every en- 
                     4
lightened %community; but  the  late  unhappy
dissentions  among its  members, have,  with
causes to be developed in the course of these
remarks, tended  to diminish its character and
restrict its benefits. A few years since, Europe
looked with astonishment on the rapid improve-
ment of medicine in this new world, and Ame-
rican physicians were the first to lessen the vast
debt which science owed. Persevering endea-
vours to  add to the stock of knowledge, and
increase the resources of his art, strict integrity,
an  enlightened understanding,  a dignified be-
haviour in  society,  and courtesy towards his
brethren characterized the legitimate disciple of
iEsculapius. No factitious claims were acknow-
ledged, the pretensions  of the  boaster  were
doubted, the pride of station yielded to retiring
merit, and intrigue disgraced only its author.
The name of brother was not then an unmeaning
word. All laboured as in  a common cause, and
every improvement  In science was not merely
an  individual but a general benefit.
   Much is yet required of  our hands, but how
sadly is the picture reversed. Assuming its func-
tions, ignorance  arrogates to itself the honours
of  this high office. The baleful weeds of empi-
ricism begin to thrive. Each no longer considers
the credit of the  profession identified with his 
5
own, but strives too often to elevate himself on
its ruins, and by undervaluing  the services  of
others, to magnify his own. Rudeness takes place
of courtesy, condescension  degenerates  into
meanness, politeness into sycophancy, senseless
vacancy  is mistaken for  silent  thoughtfulness,
and  upstart garrulity  usurps  the authority of
hard-earned  experience.  Discord  prevails, and
unless we speedily harmonize, the title  of phy-
sician will cease to be  a promise of respect.
   Shall  it  be  thus?  Shall the  proud  column
raised in this western hemisphere  by our illus-
trious predecessors be allowed to crumble ? Shall
we in our blind confusion  squander  their noble
legacy?  Hope whispers no.  Your feelings an-
swer no.
   Let us then, I beseech you, consider  the ul-
timate tendency of our present career, redeem,
if possible, our sinking character, and by a well
ordered course adorn our profession.
   Perhaps the  first step in the accomplishment
of this end, would be a right understanding
among us of the conduct proper under circum-
stances likely to occur. Unless the  moral faculty
of some  be  sadly depraved, we can easily agree
on all points involving principle, but there are
minor ones, to which universal consent, though
desirable, can  scarcely  be expected.  I shall. 
                      6
however, submit a few considerations, wliich, if
you approve, you can adopt, and to which you
are earnestly  requested to advance objections,
if any you have, in  the  spirit in which they are
offered. Before you proceed one step in their
perusal, I warn you  not to expect any thing new
or ingenious.  The  plainest understanding must
approve of the leading precepts, common sense
must dictate the propriety of their  observance;
but, alas!  their violation has been too frequent,
and it  is  more  my desire to persuade  into a
good old  path unwisely deserted, than to open
a new  road.

                    FIRST.
        Of the admission of Members.
   Believing the introduction of unsuitable per-
sons into the  profession to be one  great cause
of its  depreciation,  I, in  the first  place, solicit
the attention of those  engaged in the honour-
able office of preparing others to undertake its
arduous duties.
   Deeply  sensible  of the importance of your
task, you should conscientiously inquire whether
the candidate possess the necessary prerequisites.
If he betray any great intellectual or moral ob-
liquity, or an ignorance of subordinate branches
of education, discourage him. 
7
   If you find him qualified, apprise him of the
difficulties he must encounter, for many choose
the profession from  the erroneous  idea of its
being of easy  pursuit, become discouraged at
the approach of unexpected obstacles, and either
retire in disgust, or  remain mere drones and
loiterers in the work.
   If he engage in preparation, keep constantly
before him  its final  object.  Let him not only
enjoy your  theoretical  precepts, but also your
practical teaching.  Let him not only hear but
see. Be not content to amuse him with the pic-
ture, but show him the  reality. By neglect of
this, many  young men of  respectable  talents,
have been deceived.  Having acquired the best
theories, and  been told the most successful rules
of  practice,  they  advance  with  a  confidence
almost amounting to enthusiasm. But how mor-
tifying is their discomfiture! At the first onset
they find they must encounter an enemy that
observes no  established  rule of combat.  With
the necessary weapons at their command, they
strike not, for they know not the point of attack.
Their knowledge avails not. They fear to blun-
der, and are doomed to yield without an effort,
while the very confidence of the patient gives an
additional sting to remorse  already too severe.
Then do not merely direct but guide. Not only 
                     8
describe the road, but travel it with your young
charge.
  Those of you who hold the high rank of pub-
lic teachers, and have the disposal of the first
medical honour, should be unremitting in your
exertions. Be not over anxious to please.  If you
possess the happy talent of uniting pleasure with
instruction,  exercise it;  if not, remember, to
convey* the latter is your  duty, and, it will pro-
cure you more lasting fame.  As your labours
are arduous, your reward should be liberal, and
you  should be  content with  the just emolu-
ment of your station, using no improper means
to increase it.  All who look to you for instruc-
tion, have  equal claims,  and all the time and
attention you can  devote, should be employed
for their common improvement.  You  should
undertake to instruct no more privately, than
the nature  and  extent of your practical advan-
tages will justify.  Do not occupy in quizzing
(as it is usually termed)  intervals of time that
could be more  profitably spent in visits to the
sick.  This plan,  besides injuring  the student,
betrays  a  spirit  of monopoly  unworthy  the
cultivators  of a liberal art.
   Encourage by all honourable means  private
instructors. They both  profit the  pupil,  and
increase the respectability and fame  of a public 
9
institution,  for  every  additional  opportunity
of acquiring knowledge, has some influence.
Besides, your countenance  encourages indivi-
'ifuals to strive for higher attainment, and thus
advance professional worth.
  There is no effort you can make, too great
for the object. Pupils come to you from a great
distance and at vast expense. Perhaps  the hard
earnings of a parent which could be ill spared
from his scanty coffers, are yielded to you in
high expectation. Perhaps the future interest of
a whole family is at your disposal.  He who calls
you his preceptor, may be its only hope. More-
over, even the fate of  an entire  neighbourhood
may hereafter hang on  his practical  success.
How carefully then should you  look to his  im-
provement !
  The last and most important  office is  the
granting of medical honours, and  affording  the
more direct passport to public confidence.
   In  your  examinations for  the  degree  of
doctor of medicine, you should have  no  par-
tialities or resentments to gratify. Exact a strict
compliance  with all the prescribed requisites,
canvass well the merits of the candidate, and if
you have objections state them, with all possible
delicacy, at the proper time and place, otherwise
you may so discourage  him as  to paralyze his
                      B 
                     10
future efforts.  If  he is bound to present a me-
dical dissertation, you are under  equal obliga-
tions carefully and deliberately to read it. Want
of time will  be no  excuse  for allowing igno-
rance to pass, or  injuring the  credit and pros-
pects of the applicant by hasty misconceptions.
Expect  not a mere reiteration of  your own
views, but rather cherish a spirit  of inquiry.
Allow no  idle disputation, but give  due weight
to the arguments of your young opponent, and
if his position is well sustained be not offended.
Anger  rouses resentment, and  the vexation of
being unkindly repulsed  cannot easily be for-
gotten. Make no  unfair  exactions, for by these
you forfeit your claim to future respect.
  Finally, When  you come to a decision, the
man must be lost in the  professor. The delicacy
of friendship must  not, by  permitting you to
smuggle  pretenders into  the list,  impose  on
society, and undervalue  the  labours  of the de-
serving  candidate.  Solid  worth should be the
only claim to notice, and this should be always
acknowledged.  Then  would the diploma be a
recommendation  to favour,  and a promise of
usefulness, and the names of professors have,
at least, the weight of their  private  testimony.
Custom or  tenderness will  not exonerate the
man from censure who can, in a public capacity, 
                     11
bestow praise unsanctioned by his judgment, or
whose pen  will record what his tongue dare
not utter.

                 SECONDLY.
               Of Empiricism.
  The next cause to which I would  advert, as
derogatory to the medical character, is  the al-
lowed progress of empiricism.  As long as our art
remains in its present state of imperfection, and
disease continues so often to baffle the best direct-
ed efforts, the hope of the afflicted, and the credu-
lity of the weak, will give some  currency to the
nostrums of ignorance and fraud. But when in
any way, either indirect or positive, we appear
to countenance  them, feeble hope is kindled
into expectation, imagination  dethrones reason,
and in  the  fleeting moment  of delusion, testi-
mony is  afforded, which the  fatal catastrophe
soon falsifies. The road to fortune is now open;
the newspapers teem with accounts of wonders
never wrought, a high value is set on the mag-
num donum, and the croaking inventor and pa-
tentee swells into importance. I am well aware,
that while some are ready to commit the fate
of those on  whom all their resources  have been
exhausted to the chances of experimental hlun- 
12
 dering, many of our most  respectable brethren
 think it necessary, in order to avoid the impu-
 tation of selfishnes or illiberality, sometimes to
 encourage the use of  unpromising  remedies.
 But this requires some limitation. If any popu-
 lar remedy is proposed, with  the properties  of
 which you  are acquainted,  and you think it
 consistent with the present safety of your pa-
 tient, employ it; watch its effect, and if you find
 it salutary, candidly acknowledge your convic-
 tion, and persevere in  its use.  Even  the strict
 attention to  regimen, a patient often observes,
 while  employing some inert  article, to which
 his own fancy or the officiousness of neighbours
 led him, frequently accomplishes more than all
the prescriptions of the physician. But you are
bound to  forbear sanctioning  all unknown re-
 medies, whether they owe their adoption  to
direct inspiration, lucky  dreams, the kindness of
a stranger, the  good nature of an Indian,  or
THE NECESSITIES  OF  THE  PROPRIETOR, Whose
strong ground of confidence is his want of ac-
quaintance with medicine,  and an entire igno-
rance of the delicate fabric  he handles.
  When these are proposed,  it becomes your
duty to state the probability of imposition, and
the hazard of  employing compounds  prepared
by  unskilful  hands.  If, notwithstanding  this, 
13
 your  patient  persist  in his desire, acquiesce.
 Still, however, though he wander from you and
 venture on  dangerous ground, do not desert
 him.  If you perceive any injurious  effect re-
 ferable to the drug, interpose your authority,
 regardless  of the vender's prediction  of its
 being the harbinger of good.  Even when the
 confidence of your patient is shaken, and he is
 ready to dispense with your professional advice,
 continue friendly visits, for after all his aberra-
 tions, he will look to you for the tender conso-
 lations of humanity, when  the spell is broken
 and he sees the storm gathering thick around
 him.
   Of the many cases which fall into the hands
 of the advertising quack, the recovery  of some
 is to be expected, and whether there be  a con-
 nexion between  the cure  and contrivance or
 not he will  profit by every lucky incident, and,
 though you may be  satisfied he cannot justly
 boast  success, your mere  unqualified admis-
 sion of the fact will be made to serve  his pur-
pose, and his puff will very soon be ornamented
 with the  imposing appendage  "Recommended
 by several physicians of this place, and else-
 where."  Thus many  are made to assist his
 fraud, who  never believed in his miraculous
 powers. 
14
   In order therefore to limit, as much  as pos-
sible, his  depredations, avoid all direct  inter-
course with him.  If you are invited to consult
with  him, refuse.   This the safety of the pa-
tient  requires,  for your  chance of  success
would be greatly diminished by his blind  inter-
ference.—Many,  by consenting to meet  crea-
tures of this order in  the hope of  instructing
them, put implements into their hands which
are afterwards  mischievously applied, by their
erring judgments.
  Does any one assert that   as the people will
have their antidotes, and charms, their specifics
and Panaceas 'tis useless to  oppose them ? Let
him recur to the  origin of these absurdities he
now derides.   By  our  profession  they  were
conceived ,and by us were they  propagated, and
however ridiculous many popular notions may
now appear, they owe  their existence, in the
infancy of our science, to the profound cogita-
tions of some learned doctors. Then think  it not
preposterous  to  attempt the  substitution of
more correct views, in place of errors of our
own planting.   Every  enlightened  physician
must see its propriety, and if we once unite in
the effort the  fascinations of antiquity will
soon vanish before the  clear  light  of reason,
modern wonders in the healing art will be found 
15
 of every day occurrence, and the chance cures
 of inspired ignorance be fairly estimated.

                   THIRDLY.
                 Of Etiquette.
   In the third place,  I  would  recommend a
 strict observance of etiquette towards  brother
 practitioners.  If we expect  public regard, we
 must respect each  other.
   When you are called to consult with  one of
 acknowledged skill, let no  private feeling  of
 animosity prevent your compliance,  unless you
 find it so strong as to obscure your judgment;
 in which case indulge in no intemperate expres-
 sions, but state your objections in a calm digni-
 fied manner,  avoiding  any unnecessary detail
 calculated to prejudice the mind of the patient.
   If you are already in  attendance  betray  no
 unwillingness to have  his opinion,  but rather
 manifest a desire  to  give place to him, for a
 time.  It may even be proper, sometimes, to
 furnish an account of the previous history and
 treatment of the  case,  either in writing,  or
through  a third person.   If his suggestions are
good, adopt  them.   This proof of magnani-
mity, will secure for you the esteem of the vir-
tuous and wise,  command the respect of your 
16
 enemy, and if it do not conciliate his regard,
 will satisfy you of his unworthiness; the bosom
 that can harbour ungenerous dislike, being des-
 titute of genuine honesty, and totally incapable
 of real friendship.
  When a professional  meeting is  appointed,
 be punctual in  attendance.  Examine  the  pa-
 tient with as  much attention, as you  would if
 you  alone were responsible.  Observe strict se-
 crecy in  your after deliberations.   If the person
 you  are called  to assist be your senior, do not
 take his opinions for granted, but, with becom-
 ing modesty, judge for  yourselves; If he be
younger  or less established  in  his profession,
 show him proper deference.  Honour his office,
if you cannot respect his years.  Cold inatten-
tion  to a junior, the assumed  air of importance,
the self-complacent  smile of protection, cate-
chetical mode of address, and dictatorial manner
of advising,  all indicate  a weak mind, and are
only practised by those whose pretensions to
superiority are doubtful; the man who  is posi-
tive  of his own excellence not fearing to have
it disputed by those who witness his condescen-
sion.
  When  the  consulting physician, approves of
the plan  of treatment  instituted by the  person
first  in  attendance, he should never, from the 
17
mere love of change, propose a remedy no bet-
ter calculated to fulfil  the indication, than the
one already adopted.  This is  particularly im-
proper at the first visit.
   If any difference of  opinion  occur on points
merely theoretical, be  ready to waive your pe-
culiar views, for theories apparently diverging,
often lead to the same practical conclusion. If,
however, you do  not  agree on the  all-impor-
tant matter of treatment, endeavour  to divest
yourselves  of prejudice, and compare with can-
dour adverse opinions.  Be neither dogmatical,
nor show that hasty submission to the  reason-
ing,  and ready acquiescence  in  the  views of
your opponent, always characteristic of imbe-
cility.   If solid conviction be the result of your
debate, be not too proud to acknowledge it, if
not,  you cannot be expected to abandon ground
you consider tenable.   In  this dilemma, you
should  refer the case  to some one, in whose
judgment both confide, and let his decision be
final.
   The   attending physician  should  write all
prescriptions, communicate all directions, and
(except where the other  is called for the pur-
pose) perform all operations.
   Neither the patient nor his friends, are to be
made acquainted with any discordance of opin-
                     C 
18
ion, that  may have  occurred in your private
conference;  a knowledge of this being only cal-
culated to lessen confidence in both.   All must
appear to be  the  effect of mutual agreement;
I, he, and they,  must be  obsolete words,  and
you must  not  say by whom  any  particular
remedy was proposed.
  Sometimes the urgency of the case, or the
solicitude of  friends requires  you suddenly to
visit the patient of another. Here, if absolutely
necessary,  prescribe  without  delay,  but let  it
be distinctly understood you consider your ser-
vices vicarious, and expect to give place to the
person  of  their more  deliberate choice.   Af-
ter  his  arrival continue only  long enough,  to
furnish  any requisite information or  assistance.
If his politeness or the gratitude of the patient,
dictate an  invitation  for  your return, do  not
impose on their courtesy,  but repeat your vi-
sit  only after  a regular call.   Decency makes
the request proper, and modesty renders your
hesitation equally necessary.
  In your visits of friendship or civility, you
will frequently be asked your  opinion, of a case
under the care of another.  If you think it con-
sistent with truth, declare your entire  satisfac-
tion with his views, and encourage a strict com-
pliance with his advice; if not,  betray  not, either 
19
by  word  or action,  any disapprobation. The
doubting look, and portentous  shrug, are even
more unmanly than open censure.
  If the  petulance or impatience of the sick,
betray them into unguarded expressions of dis-
trust or dissatisfaction, honour forbids your tak-
ing  any advantage of the circumstance.   You
are  bound  to endeavour to  satisfy doubts and
re-establish confidence, and if you cannot effect
this laudable  end, let not a repetition of the
complaint pollute your breath.   Though secre-
cy be  not enjoined by the disaffected, the ob-
ligations of your  profession impose it.  Light
not the torch of discord at the  altar of suffering
humanity.
   If in any of  your  friendly  calls, you  find a
brother  practitioner  in an error,  remonstrate
with him privately,  and  if you  convince him,
boast not, but be content with the satisfaction
of well doing.   If he persist, leave him to his
own will, unless his  mistake be so gross as to
prove him  unqualified for the important duty
he has undertaken.   In this latter case interfer-
ence is justifiable ; and it might be proper to in-
sist on a reference  to a third personj always,
however concealing  your suspicion from the
patient or his friends.
   If in any instance caprice or some slight mis- 
20
 understanding induce a patient abrubtly to dis-
 miss his physician,  the successor may  not be
 bound to inquire  into the  merits of the  case,
 but should  resent  any unjust censure, or re-
 prove any  dishonourable  insinuations.    If it
 be  in  your  power to reconcile differences,
 spare no exertion*   Bearing in mind the sa-
 cred injunction, of doing to others as we would
 they should do  to us; employ every honourable
 effort to procure his restoration,  and cheerfully
 retire before him.   If you cannot effect  this,
 ascertain from him that  he considers himself
 finally discharged, and assure him of your own
 amicable disposition.
   Sometimes the  representations  of patients
 are calculated to  lead to  a misconstruction of
 the  conduct and  motives  of  another  practi-
 tioner.  In such a case you should not  betray
 any premature resentment.   Have an interview,
 and endeavour to come to a right understand-
ing with him, and, if his explanation  do not
 even accord  with  the   previous  statement,
 credit  him,  unless  he is  evidently  inconsis-
tent.
  When any dispute occurs between two prac.
titioners, which their mutual explanations  can-
not reconcile, the  opinion of a common friend
should be taken, and if this fail of  producing 
21
the  desired pacification,  and a  more  general
appeal is  thought necessary,  let it  be  strictly
confined to the profession.  A public exposure
of real grievances seldom answers the purpose
of the injured, while the  rehearsal  of  fancied
wrongs meets with ridicule.   The world is too
indifferent of  individual  concerns, to examine
with  care  into the grounds of  misunderstand-
ing.  Nor, indeed, is it always capable of a cor-
rect decision,  none but men in the same  pro-
fession, being qualified to appreciate the ground
of difference.  He that  expects to fire the com-
munity with  his  indignation,  however  just, is
in great danger  of  disappointment, for party
feeling  and prejudice  will always weigh,  and
after all charging and  rebutting,  the previous
standing of the parties will be made the lead-
ing question,  and though both  are degraded,
injustice, if high handed or official, may  prevail.
Time will often  effect, what haste may  defeat.
It is better therefore to wait  its slow working
than incur the hazard  of  adding  mortification
to injury.

                 FOURTHLY.
   Of the mode of obtaining Medical Offices.
  A laudable  ambition  will  excite  every man
of dignified feeling or noble sentiment, tq strive 
22
for excellence, and  induce him  to value every
honourable mean of professional advancement,
as the road  to  that eminence, his superior ta-
lents, or  higher  merit, entitle  him to hold.
When such an  individual finds  an avenue to
promotion open;  his serious inquiry is whe-
ther he is qualified to fill with credit to him-
self, and service  to  others,  a post of honour,
or profit.  To possess an exalted station with
inferior claims,  he would never desire ; know-
ing full  well, under  such  circumstances, eleva-
tion would be disgrace.   Nor would the love
of precedence ever induce him, to  resort to
any  measure  for  its  attainment,  which  the
finest delicacy would  not  approve,  or strict
integrity warrant.
  But there are inferior souls, who forgetting
the true  aim,  make  priority  of place their
measure of desert,  and pant for its attainment,
without seeming to  consider that excellence
alone can make it  honourable.   These know
not how to make station respectable, by  ster-
ling merit.  All  they have learned, is to value
themselves on it.   Promotion  is the just re-
ward of merit, but can furnish no solid preten-
sion to it.
  What beauty can  a  mirror reflect,  when de-
formity is placed  before  it ?   What  credit 
28
can  lofty situation give;  to an  unworthy in-
cumbent ?
   When men  of  the latter description, start
for eminence, they soon find the road of virtue,
too steep and rugged ; turn off into the by path
of intrigue and manoeuvre, seizing  on  any ad-
ventitious  aid, unmindful  of every thing  but
the attainment of their purpose.
       u A friend or brother, they defame,
       And sooth, and flatter, those they hate."
With them the end justifies the means,  and no
honourable competition  can be  expected.   It
is therefore not surprising, that in a contest so
unequal, merit should be sometimes cast  into
the  shade, and public favour be injudiciously
bestowed.  Here,  however, the successful need
not boast their ill-gained victory, nor the more
deserving envy them, for  the light these ephe-
mera seek, will be their destruction.
  The mouse may climb above the imprisoned
elephant, or the ass  assume the lion's skin,  but
a squeak or a bray must soon expose their low
nature.  Solid  virtue can  only  pity towering
meanness, and despise exalted demerit. Jealousy
is a  fault we should  never  be betrayed  into by
those who purchase advancement with dishonour.
All we have to regret is the character they  for
a time give to the profession. Having  reached 
24
a height which  renders  their faults more con-
spicuous, they shamelessly indulge them, in the
belief that they are above censure.   Constant
exhibition renders the picture  more familiar,
vice becomes less odious, dishonour  loses  its
asperities, example soon palliates what virtue
condemns, artifice and juggle grow fashionable,
and many employ the false currency because
unable to detect the imposture.  What they de-
sire they unhesitatingly seek, and precedent ex-
tenuates  even guilt.  It is sometimes  inconve-
nient to recur to first principles, and custom is
made the ready plea for their violation.
  Thus, by  a system  of overreaching we are
working our own ruin.  But let me ask the man
who owes his promotion to unfair management,
where is his satisfaction? Can he  enjoy his vic-
tory over a rival only less fortunate because
less intriguing?  Can he witness  the downfall of
his profession and plume himself on  his  own
elevation? Can  he find public regard withdraw-
ing itself from  him, and console  himself with
the thought  that others are more dishonoured ?
  It is not my wish, however, to be understood
as bestowing indiscriminate censure,  even  on
those who  deviate from the line of  rectitude.
There  are   doubtless  honourable  men,  who,
thinking it  necessary to adopt the motto do in 
25
 Rome as Rome does, believe themselves justifiable
 in  meeting  their  competitors  on their own
 ground;  but we  fear too  many, conscious  of
 inferiority, plead  custom, and pursue unmanly
 measures  as  their only  hope of advancement.
 To the latter I have nothing to say—with them
 reproach or persuasion would be alike ineffec-
 tual—let them, if they can, glory in  their own
 disgrace.  The former will (I  trust)  gladly em-
 brace a more honourable policy, and them solely
 I now address.
   If, on the creation or vacancy of any place
 which you think yourselves qualified to fill, you
 determine to seek its attainment, make a fair
 and regular application, and if you have supe-
 rior claims state them respectfully. Urge nothing
 with the earnestness of the suppliant, but show,
 by your independent, though polite manner, you
 deserve what you ask.  Never condescend to the
 base trick of electioneering. To a noble  mind
 obligation is always painful,  but who  that pos-
 sesses one  spark  of generous sentiment  can
 brook the thought  of soliciting favour  from
 those he lightly esteems? Every man, however
 humble his station, if he fill it with integrity,
 should be treated with  respect; but mere moral
 rectitude cannot enable him to judge of intel-
lectual worth, or  scientific attainment.  Now  it
                     I) 
26
often happens, even where men strictly honest
are preferred to the management of public in-
stitutions, that stupidity, or ignorance, or both,
characterize the individual whose decision is to
influence your fortune. Here you should possess
too  much  real dignity to  allow yourselves to
urge claims where they cannot be appreciated,
and thus acquire the reputation of empty brag-
garts. To boast superiority before men entirely
unqualified to estimate  medical pretensions is
degrading; but to court, and compliment, and
flatter, and importune those whom, under com-
mon circumstances you would be scarcely will-
ing to recognize, is meanness in the very ex-
treme. Whatever is  reduced to  the  level of a
mean capacity will be lightly valued. This course
of office  begging,  and favour   seeking,  must
therefore, defeat its object, for in this way pre-
ferment can only be bought by a sacrifice of cha-
racter.  Moreover, it is almost universally true,
that  rapid  growth  indicates speedy decay,  and
the man who rises into notice by a puff will
soon  find his airy height  dangerous,  and his
support feeble.
  Then do not, as  you regard  the  interest of
the profession, and your  own ultimate advan-
tage,  follow  the unworthy course.   Let your
acquirements be solid, your  principles sound, 
27
your resolution firm, your attention  strict:  In
a word, make yourselves useful and necessary
to the  public, and wait the event.  Your ad-
vancement may be  slow, but  it will  be sure
and lasting.   The breath of popularity may be
unpropitious for a time, but it cannot harm you.
Even its reproaches will leave you spotless.
The deep extending root makes no display, it
grows  unseen, and  works  almost  unheeded,
but when the storm  gathers,  it  sustains  the
stately tree, and, if in the  conflict its foliage is
stripped,  has power  to  renew its  spreading
beauties.  When the elements  are hushed, and
the sky becomes serene, we admire the  virtue
that defied the blast, and the succeeding calm
invigorates its strength,  and   develops new
graces,  while the  solar  warmth, but tends to
wither the fallen honours of  unrooted  ambi-
tion.
   Injured excellence must revive, but there is
no redeeming principle in unmasked worthless-
ness.

                  FIFTHLY.
         Behaviour  towards Patients.
   When your professional aid is  solicited, no
private  misunderstanding should deter you from
granting it. No imaginary slight should be made 
28
the  pretext  even of a  moment's  hesitation;
for while you pause to settle a trifling punctilio,
the destroyer may complete his work.  If you
know you have been injured, prove in the hour
of danger that you deserved better  treatment;
if the patient  have seemed regardless of your
feelings, show yourselves mindful of his safety.
True manliness  would scorn to resent an of-
fence on a prostrate enemy, and heaven born
charity invites to the noble satisfaction, of re-
warding evil with good.
  When  you  arrive at the scene of affliction
indulge not a  sickly  sensibility, but  evince, by
your  tender deportment,  that familiarity with
human anguish has not blunted the sympathies
of your nature.  Avoid  all  appearance of bus-
tle and hurry, and endeavour  under  the most
imperious circumstances,  to be calm,  collec-
ted, and deliberate.   Once determined on your
course act decisively;  remembering all huma-
nity can effect, depends  on you.  Be not  of-
fended at  the embarrassments, the anxious so*
licitude, or even the unreasonable fears of  the
patient or  his  friends,  may occasion.   Both
may seem to  forget the deference  they owe,
and evince a disposition to  interfere with your
plans: But you should not resent at  that mo-
ment, their   well meant,  though,  ill judged. 
29
suggestions.   Neither indulge  in  angry invec-
tive, nor abandon your patient.  Stand  firm to
your purpose while circumstances urge.   When
danger is over and alarm has subsided, you will
generally  receive  the  grateful  acknowledg-
ments of  those, whose  disquietude betrayed
them  into opposition.  Even when  the event
is unpropitious,  you  will find satisfaction in
having exercised forbearance.
   When your opinion of a case is requested, do
not give  an undue importance to your services
and  create unnecessary alarm,  by magnifying
the danger, nor fall into the opposite error of
inducing a false  security.
   Nor are you  ever to create  entire despon-
dence  ; your exertions should continue to the
last moment,  and a state of absolute despair,
might  altogether prevent a compliance with
your orders, or  paralyze  the  efforts  of those
on whom their  execution depended.   Though
the faint rays of hope may be permitted to
beam  on  the darkest  prospect, they  should
not be lighted into  expectation.  Deceive not
a dying man, lest his last accent declare  his dis-
appointment, and the cold breath of dissolution,
be  spent  in  accusations, which  your  own
wounded conscience must acknowledge just.
   To the interrogatories of friends you should
give as plain and satisfactory answers as possi- 
30
 ble. You cannot expect your explanations to be
 well understood by the mass of people, even
 when you employ the most common language;
 much less when they are conveyed in technical
 and high sounding words, with which they are
 as little acquainted as with an  unknown tongue.
   When  a consultation  is requested,  show a
 ready compliance. If you think it necessary for
 the safety of the patient or your own satisfaction,
 make the proposition yourself. If the alarm of
 friends  urge them to  ask  it before you think
 circumstances require, be not displeased at  the
 appearance of distrust,  but remember their fears
 suggest what their cooler judgment would not
 dictate.
  If,  happily,  you  possess  religion,  neglect
 no suitable opportunity of urging its importance,
 or applying its truths, and when its solace is  de-
 sired, be ready to present it. You may then adapt
 your conversation to the condition of your pa-
 tient, prevent an interruption  of  your curative
 efforts, and contribute to wipe  off the foul and,
 I would fain hope, unjust charge of infidelity, so
 generally attached to our profession.  But if you
 are  unqualified  for this divine service,  do  not
 object to the visits of the pious. The frigid rules
of human philosophy may teach us to bear with
sullen fortitude the common Uls of life, or meet
with heartless submission  the  irrevocable sen- 
31
tence " Dust to dust,'' but it is only for the sub-
lime precepts of Christianity to inculcate holy
resignation. The hallowed light of religion can
alone brighten the gloomy prospect of the dark
valley of death, and  its cheering promises are
the choicest opiate to sooth the last agony.  By
its sweet influence, the painful hesitation of un-
certainty and trembling apprehensions of alarm
are changed  into  joyous expectation.   Faith
points to bliss beyond the grave,  and the glad-
some hosanna is the last sound  sent back  to
earth, as the  heaven bound traveller embarks
on  the wide ocean of eternity.  Then do not
despise  the advocates of a meek and  humble
Saviour, but permit them to unfold his glorious
plan. Not that you should  allow every gossip-
ing  enthusiast to harass the already troubled
mind of your patient. Commit h^m to the care
of  enlightened, judicious piety—to  one who,
while he probes the depraved heart, and opens
it to a sense of its  unworthiness,  has the balm
of  Christian  consolation to offer;   and who,
while he warns of the danger of the dark abyss,
can direct to the region of celestial beatitude.
  Finally,  In all your intercourse with the sick,
be mild, forbearing, attentive and affable; equally
avoiding to excite fear  by austere reserve,  or
create disgust by rude familiarity. Be not con- 
32
 tent with the mere formality of prescribing, but
 when necessary be the friend, the comforter,
 and the nurse of your patient.  If he be a stran-
 ger in a strange land, perform every kind office
 in your power.  Remember he may have known
 the anxious care of parents  and  the soothing
 tenderness of friends, and now, while in painful
 separation the hearts of many are yearning after
 him, neglect may sink like  a dagger in his
 breast.  The remembrance of past attention  may
 but aggravate the sting of present indifference,
 and grief and despair finish  what disease es-
 sayed.

                  SIXTHLY.
                Of Charges.
   The appreciation of services, though it may
 seem to be an  individual concern, has a great
 influence on the general character of the pro-
 fession.   If our time and attention  must be oc-
 cupied in relieving affliction, those  who receive
 the benefit of our labours should acknowledge
 our claim to a suitable reward.  But as we prac-
 tise a liberal  profession,  we should  not value
 our service by measure,  nor number our visits
as the merchant does his wares, and  expect a
like  return from all.  Our charities  should be
great and frequent; and, in order  to enable us 
33
to exercise them, our compensation should be
proportionately liberal.  Not that we should al-
ways expect a large fee, for there are many can
only afford a moderate one, and if they can well
spare this we are not to reject it. But we should
fix  for our common  guidance the  rates of
charges; and when we make any deduction, let
it be understood that it is in  consideration of
the patient's finances, and if these are very low,
let our services be entirely gratuitous. Take not
a pittance from the hard earnings of the poor.
What if by persevering industry  and a long
course of self-denial, he may have treasured up
a mite for us ?  Then is he  more worthy our be-
nevolence,  and we should never allow his noble
honesty to  deprive him of the comforts, or per-
haps the necessaries of life.
  If we desire the respect and confidence of
our patients, we must not extort money from
them by invention.   Some from undue love of
gain contrive to make those who ask their pro-
fessional aid a double source of profit. Not con-
tent with a just compensation, they persuade,
and  sometimes force,  (by employing  private
marks, and otherwise,)  patients to  purchase at
an enormous price, medicines of their prescrib-
ing,  either directly  from themselves, or from
some one with whom they have a secret under-
                     E 
34
standing. Even where the afflicted are unable to
afford a regular  fee to  their  physician, and
where he thinks it would be barefaced inhuma-
nity to exact it, he sometimes has the cold bar-
barity to fix a high value on  his prescription,
and thus pinch from the hard hand  of poverty
the gain he would be thought to forego. It is not
unusual to hear men of this cast accused of pre-
scribing more largely and frequently than ne-
cessary; and,  indeed,  we must acknowledge
there is at least  a semblance  of truth   in the
charge.    It  is  perfectly correct  for  a phy-
sician to engage in any  private concern that
does not interfere with the proper discharge of
his regular duties, or hazard the credit  of  his
profession; but if he be interested in the vend-
ing of medicine, he must not incur  the imputa-
tion of  being  mercenary and unjust, by  mono-
polizing the profits of his own prescriptions.


                 SEVENTHLY.
      Of the Advantages of Consolidation.
   As there are many measures which for their
enforcement require,  not only implied consent,
but a positive understanding among  us ;  I would
urge the necessity of our associating together,
(as has been done in a neighbouring city) and 
35
adopting rules,  for  our general government.
There are  many points  that  cannot  other-
wise be well observed, for the rules which one
may have  prescribed  for  himself,  may allow
more latitude  than those  of another.   For in-
stance, one may  refuse to meet an  empiric,
while another in  perfect consistence  with his
views of propriety, may consent.  One may feel
himself bound to decline  all attendance on the
patient of a brother physician, until  he is either
regularly called to meet him,  or  learn from
him that he is fairly dismissed, while another
may be satisfied with  the  assertion of the pa-
tient or  his friends.   One may acknowledge
medical pretensions, which others  may disre-
gard.  Some may think it proper to accept or
even ask a situation, of which a worthy brother
has  been improperly  deprived,  while others
may consider  it highly dishonourable.  Some
may believe an offence against  an individual
member a  general, others a  mere private con-
cern.  Want of coincidence in these, and many
other subjects, greatly diminishes  the weight
and respectability of  the medical  character.
The strict etiquette of one, is  often mistaken
for foolish nicety, and the inattention of ano-
ther, attributed to rudeness;  and thus equally
well meaning  persons, sometimes  misunder- 
36
stand each other, accusation and recrimination
follow:  the public is troubled  with their mu-
tual complaint,  and the  general credit injured.
If we woidd organize ourselves into a regular
body, we could establish fixed principles of con-
duct,  and when any violation occurred, all
would know how to treat the offender.   Then
disputes might be referred to competent judges,
and public appeals be  rendered  unnecessary.
When a  physician forfeited  the respect of his
brethren,  all  would  concur in withholding it
from him, and  though  his professional worth
might be recognized, the general  suspension
of friendly intercourse would be ample punish-
ment.—If one member were  injured or slight-
ed in  a public way,  the  whole body would feel
bound to resent it, and  we would not  then
hail party feuds, or  individual  debasement, as
opportunities for personal advancement.
  There is one point that cannot be properly
settled, but by  common concurrence, and at
this I have already  hinted.  I  mean the rates
of charges.   To our  disgrace we have now,
among other matters to  be gained at alow rate,
cheap doctoi's.   The poor consider  the trifle
they afford their physician, a full compensation,
the rich reason  from this,  and resent what they
term extortion when a fair demand is made, ap- 
                     37
ply to another who, for fear of offence, mea-
sures his services by their narrow standard, thus
justifying their censure, and becoming the plun-
derer of the  field  he  ought to enrich.  This
should not be.  Yield every thing  to necessity,
but nothing to avarice; and remember when
we undervalue our own  labours,  we  rob  our
profession.
   In addition to the unanimity among ourselves
likely to result, we would derive another great
advantage from association.  The  public gene-
rally  would  cease  to  make unreasonable re-
quests,  and see the propriety of some nice ob-
servances they now condemn. Many things cen-
sured as private acts,  would be approved when
understood to result from common agreement.
While individual conduct remained blameless
the  reputation  of  the profession would  be
pledged for  its  support, and  our characters
would cease to be at the  mercy of every man
who chooses  to  constitute himself judge, and
whose reproaches we now justify by our con-
stant bickering.

                 CONCLUSION.
   An earnest  solicitude for the interest of my
profession prompted this address.  I have  not
insisted on the general and essential qualities of 
38
the gentleman to the formation of the medical
character. These the physician should of course
possess;  for, without private worth and respec-
tability, the  highest intellectual attainments or
greatest public service, cannot secure a lasting
name to the individual, or credit to his profes-
sion.
  1 am sensible that while many necessary rules
of conduct are entirely neglected, the few I have
placed before you  are very imperfectly discuss-
ed.  But in my feeble judgment they were  most
important, though too seldom observed, and a
favourable reception of this hasty sketch, may
encourage at a future day the attempt  at a  more
minute and  better  digested plan.
  Many may be disposed to smile  at some of
my suggestions as visionary, and wish to remind
me that it is less difficult to advise well than act
correctly. I am no advocate  for human infalli-
bility, and cannot therefore answer for my own
firmness.  While we are the subjects of evil pas-
sions, private animosities must exist. But though
we may expect often to feel resentment against
individuals,  we should all be willing  to pledge
ourselves, as far as in us lies, to consult the in-
terest of  our profession, acquiesce in any rules
that may be properly instituted by it, and hold 
39
ourselves  liable to whatever discipline or cen-
sure a violation may merit.
   If my observations could but have the effect
of gaining your attention and exciting you to
action, my purpose would be gained; but if apa-
thy continue to prevail, I must console myself
with the consciousness  of the purity of my in-
tentions, and though I fail in the execution rest
satisfied the design  is  good. 
•<                       »