AN GR.ABUATES OF THE HXEBZCAL COLLEGE OF SOUTH-CAROLINA; DELIVERED OX MARCH 23D, 1829, AFTER CONFERRING THE DEGREE OF DOCTOR IN MEDICINE. 1^_ BY i HOIVIAS Y. SIIVTOi S, IKE. D, President of the Medical Soeiety of South-Carolina. SECOND EDITION. CHARLESTON: PRINTED BY A. E. MILLER, No. 4, Broad-street. 1829. Charleston, 8th April, 1829. Dear Sir—I consider myself as authorized by the following resolution, (presented by me, and unanimously adopted by the Society,^ to request that you will neither decline nor delay a publication of your Address, at the late Commencement of the Medical College of South-Carolina* In behalf of the Committee, Your's respectfully, HORATIO S. WARING, M. D. Medical Society, Charleston, 1st April 1829. " Resolved, That the thanks of the Society be presented to the President for his excellent and useful Address, delivered at the late Commencement of the Medical College of South- Carolina; and, that a copy of the same be requested for pub- lication." A true Extract from the Minutes, J. DE LA MOTTA, M. D. Secretary. To Dr. Thomas Y. Simons. JLDD23SB. GENTLE MEN GRADUATES, You have now received the honours and privileges of the Medical Profesion : Your con- nection with this Institution has terminated, and you are about to enter upon the active duties of life. The elementary principles which you have learnt are to be practically applied, and you must bear in mind that the health and life of your fellow creatres are involved. The duties of the Physician are great and responsible—his relation to society important and respectable. No class of individuals have greater means of being useful, or contributing to the happiness or character of a community ; and where these means are properly exercised, none are more respected or beloved.' But to accomplish this, the Physician must bring into action the excellencies of the head and heart; he must unite humanity and sympathy with intellectual acumen and decision of character, and his whole life must be a continued course of study and observation. The pathway to medical 1 eminence and success is rugged and steep ; multi- form difficulties have to be encountered, and much self-denial as well as perseverance, with unabated ardour and zeal for a continued series of years are necessary to obtain a comfortable competency, or the confidence and respect of a community. But, Gentlemen, to the noble and aspiring mind, difficulties and obstacles act only as powerful incentives to proper and effective efforts to overcome them. If there be no piofes- sion more calculated, at first, to damp the ardent aspirations of the ambitious or sanguine, none ultimately rewards more fully his honourable and successful efforts. You must not, therefore, be discouraged because you are slow in getting employment, or have not the entire confidence of those who do employ you;—it is the fate of all who have preceded you. Life and health are dear to every one, and it is natural, from your limited experience, to question your skill, until satisfactorily substantiated. As the mathemati- cian has to arrive at the termination of his pro- blem by a succssive train of proofs, so the physician has to prove his claims to skill by successive and successful applications of his medi- cal knowledge. What you have learnt must be regarded as only f pening the veil and exhibiting to your view the 5 extensive and rich field of intellectual attainment for your subsequent labour. The change which you are now to make in your relation to society, it is impossible for you to realize. You are about to assume the solemn responsibility of becoming the guardians of the health and life of your fellow creatures. In your hands these precious deposits are to placed. Such confidence demands of you proportionate moral and intellectual worth. No labour or sa- crifices, therefore, should be regarded as too great, which will enable you to fulfil, with ability and fidelity, so sacred a charge. The human constitution is a wide field for observation, materiilly modified by climate, cus- tom, and habit—and luxury has brought into her train abundant additions to the numerous diseases which mankind are naturally heir to. These various forms and modifications are only to be known or judiciously met by a well grounded knowledge of your profession, with minute, labo- rious and patient observation. You are not to depend alone upon what you have heard or read, but must look to the bed-side of your patients— watch nature there, and observe the various phe- nomena which the animal ceconomy exhibits in disease. The labours and experience of others, it is true, must at first be principally your guide, 6 and it is incumbent on you always to ascertain, and pay due attention and respect to them; at the same time taking care to observe and think for yourselves ; and, when you feel satisfied jou have arrived at correct conclusions, to act for your- selves, although it be not in accordance with your antecedent opinions or standard authors. In doing this however, beware you do not fall into an error too common with youth and inexpe- rience—become rash and dogmatical, and dis- respectful to the opinions of your elders in prac- tice, or despise all authority, and arrogantly rest upon your own judgment. Let me urge upon you, Gentlemen, not to suf- fer your minds to be too much entangled by the fascinations of theorists. Nothing is more dan- gerous, or sure to shut the mind up from im- provement than a slavish devotion to any medical doctrine; and it is among Tyros in the profes- sion, that theorists gain their numerous prose- lytes. Read the history of medicine, (and it is well worthy your attention, for you will, in this manner observe, the claims which the different theorists have to merit and respect as well as the errors they have fallen into,) and you will find, from Hippocrates to Broussais, the continued effort has been to make all observation and evi- dence subservient to the illustration of certain 7 general principles—the Humoral Pathology and Ar- chaeas of Hippocrates and Galen, forexample—the Alchemical doctrines of Paracelsus, and Van Hel- mont—the Mathematical calculations of Pitcairn— the Phlogiston and Vis Medicatrix Naturae of Stahl and others—the Vis Insita of llaller—the Vital Principle of John Hunter—the Spasm of extreme vessels, and Excitement and Collapse of Cullen— the Excitement and Excitability of Brown—the the Sensorial power of Darwin, not to mention many others, have all had their numerous and devoted adherents, whilst at the present day the docrines of Rush, Armstrong, and Broussais are in their respective countries predominant. All of these doctrines (many of which are not es- sentially different) have many things valuable and good, and have added something to the illus- tration of the principles of medicine. But with out wishing to undervalue the labours of these deservedly great men, I must say they have many things which the judicious and discriminating physician will find cause to reject. Indeed the maltifarious and discrepant opinions in medicine have been the abundant source of irony, and have induced many sensible persons to question its absolute utility, or at least to have their confi- dence in medical skill much impaired. The happy and humorous description by the poet of 8 the warm and angry speculations upon the colour of the cameleon, may be regarded as no inapt elucidation of many medical speculations and opinions, and however we may luugh at San Gra- do and Gil Bias, there have been, and are many real personifications of such characters ; nor was Moliere so very far wrong in his Satires upon many absurdities in our profession. But to return :— It is one thing to generalize and another to apply these generalizations to actual practice ; and many things, which, according to ) our read- ing appear simple an 1 easy in practice will prove formidable and embarrassing. You will find, that the human constitution is as variable as the climates of the earth, and the habits and luxuries of man, and what would be suitable in one age or country would not be so in another. It is the pro- vince, therefore, of the practical physician, to examine scrupulously, and with scepticism, the various doctrines and opinions, and their respec- tive claims to attention. Like the judge he must hear with impart iaiity, all their evidence and arguments and thus be regulated in his decision. You will see that the physician, who aspires after eminence and success, has to assume very important functions. It is necessary, therefore, that he should be fully prepared, and intimately acquainted with the principles of his profession, 9 and the different branches which compose it.—' Above all he must understand the animal structure ; the operation of the several organs in health, and the changes which are produced in them by dis- ease. This embraces a knowledge of anatomy, physiology and pathology, the basis and test of all medical opinion. Let me impress upon you the absolute necessity of an accurate knowledge of this department of your profession, to perform faithfully your trust. He who is ignorant will be in con- tinual labyrinths and perplexities, with no light to guide him, and become either the wslave of every new doctrine, or the reckless, rash and obstinate charlatan. There are, it is true, many very good anatomists, physiolygists, as well as pathologists, from a want of observation, judgment or discrimi- native power, who are indifferent practioners; but there never was a physician or surgeon, of de- served eminence and success who was ignorant on these points, although there are many who may have a vast deal of business and a factitious reputation. To enlarge upon the character and importance of the different branches of medicine, would on this occasion be a matter of supererogation. In the progress of your studies you have had abundant means of appreciating their respective value, and observing how far they are necessary to be known, as practically useful in your profession. 10 There is one department, however, which, not having become a part of a medical education, I cannot forbear cursorily calling your attention to. I allude to medical jurisprudence. In all cases where medical illustration or explanation is required, the physician is called into court, and his opinion materially influences the decision of the judge and jury. In wounds, poisons, mental aliena- tion, legitimacy, infanticide, and many other cases involving the life, honour, or property of an in- dividual, your opinion will be required; and to assume this solemn responsibility, without using proper means of becoming fully adequate to such a charge must be regarded as at least reprehensible, if not criminal. Your reputation and character are on such occasions, at stake and errors might visit you ever afterwards with disgrace. I recom- mend to your particular attention on this subject, the work of our countryman, Dr. Beck, as well as Paris and Fonblanque ; and Tracts on medi- cal jurisprudence, with notes, by Dr. Cooper, of this State. Some of you it is probable, will not enter upon the active duties of your profession, or be induced at some period to withdraw. To such I would suggest the propriety of investigating some one of the collateral sciences. Chemistry presents innu- merable fascinations to the philosophic mind, and 11 has contributed more than any other department of natural science to the advancement of the arts, and the improvement of the condition of the human race. Ouy country, but partially explored, opens a rich and abundant field to reward the la- bours of the geologist, mineralogist, naturalist, or botanist. In these several departments you will not only have an inexhaustible source for elegant employment, but may become ornaments, as well as benefactors of your country. Let me urge upon you all the importance of pay- ing to classical literature, ancient as well as mo- dern, continued attention. I recommend this par- ticularly to you, as calculated to contribute ma- terially to your success ; for you well know that they very much tend to refine the taste, elevate the feelings, enlarge the mind, add greatly to profes- sional and intellectual character, and command the respect of the wise and accomplished. You must not look merely to the pecuniary gains, but to higher and more ennobling aspirations—the elevation and dignity of your profession. The glory and renown of a country, like the splendour of an edifice, consists in the proportion and perfection of its parts. If the warrior or the statesman have their actions emblazoned in the heraldry of their country, so, likewise, the philoso- pher, the scholar, the jurist and physician, hold 12 conspicuous stations in the intellectual character of a nation. Socrates, Archimedes, Plato, or Hip- pocrates, have contributed as much to the im- mortal glory of Greece, as Solon, Demosthenes, Themistocles or Leonidas. It is the intellectual character of a people which secure to a nation her immortal honour and reverence. You must, there- fore, remember, that you are to look not only to your own advancement, but to the good of your country and mankind. Before we part, Gentlemen, I feel it incumbent upon me to point out some moral duties which it is important for you to bear in mind, and some habits which it is indispensable for you to avoid, if you as- pire after professional excellence. It is unreason- able to expect perfection in the conduct or beha- viour of any class of men ; but in proportion as the standard of medical excellence is elevated, will be its respectability and usefulness, and its rank among the occupations of life. The relation between yourselves and your pa- tients, will of necessity be of the most confidential kind. Whatever you see or hear, therefore, must be as sacred as your honour. He who violates this trust, prostitutes the high calling of his profession, and is deserving, and will inevitably meet with the contumely of an indignant commnuity. You will be regarded by most of your patients, not only as a 13 professional man, but as a friend, to whom they can lay open their sorrows and troubles, and from whom nothing will be concealed which will facili- tate, in the alleviation of disease ; and the mind of sensibility and honour will duly appreciate such enlarged and delicate confidings. Endeavour to become the friend of your patients, for in this manner you can alone obtain their entire confidence, and have the means of doing full jus- tice to them and yourselves. In sickness the mind is often petulent and capri- cious, and always more or less disordered. You should bear with the effect of these, insomuch as it does not infringe upon what you may conscien- tiously consider your professional duty. Here all compromise must terminate. The life or health of your patient is paramount to all other considera- tions, and to temporize with them w>uld be crimi- nal. I hold the physician who would accord with the prejudices or caprices of his patient, or the friends of his patient, in opposition to his conscien- tious conviction of its impropriety, for the sake of popularity, or the dread of being dismissed, an alien and disgrace to his profession and humanity. But while it becomes the physician to maintain his opinions, and to be firm and resolute, he may be yet mild and persuasive, and endeavour to con- vince. To be harsh and authoritative is the worst 14 means to obtain an end, and even if he prove suc- cessful, it is frequently at the expense of esteem.— There are few persons who will not listen to reason, if properly urged; but should any prove unrea- sonably obstinate, it is the imperative duty of the physician to withdraw as he can be no longer useful. It has sometimes been the fashion (and you must pardon my bringing it to your notice) for young physicians to assume a consequential, positive and dogmatical manner, and think it an important ac- companiment of their profession. Men of talent will succeed with these disadvantages, for know- ledge is, unquestionably, power; but they will find it the cause of making men of very inferior compe- tency, formidable rivals in their medical career. Whereas amiability of deportment, delicacy of feeling and prompt attention, associated with ta- lent and acquirement, give to the physician a standing as firm as adamant; for here the head and heart are enlisted in his cause, and all opposi- tion must prove vain and nugatory. He can then defy the shaft of malice or the plausibilities of cun- ning. When, Gentlemen, all your efforts have proved unavailing and death approaches, shrink not from the last agonizing duty. It is harrowing, indeed, to the sensitive mind, to have all his exertions fail; 15 the hopes and expectations of anxious relatives blighted, and the house of joy converted into the house of mourning. Yet even then, he can pour into their bosoms the balm of consolation, and assist to relieve their intolerable anguish. Then the duties of the physician has terminated, and the friend commenced; and, believe me, that at- tentions on such occasions make an indelible impression. In your professional avocation your services will be required by all classes and condition of men. The poor and unfortunate have a peculiar claim upon your attention. I do not mean that your time should be devoted to them, to the neglect of those who compensate you—this would be un- reasonable and unjust—but you will generally have time to attend to both, and it would be disgraceful to refuse the means which God has given you to alleviate the afflictions of your fellow-creatures. If there be a situation in life peculiarly enviable, it is that of the physician of enlarged benevolence, ministering to those who, having seen better days, are now weighed down with poverty and disease ; sympathizes with their sorrows, ameliorates their sufferings and receives in return their grateful benedictions. There are many who have all the disposition but not the means of fully compensating you for your 16 services. Distress them not. Accommodate your- self to their means. Sickness or death are of themselves terrible afflictions to a family; but to add to them merciless and grasping cupidity, is a consumation of inhumanity. That our escutcheon has sometimes been stained, is a melancholy truth, but such profanation, for the honour of our profes- sion, has been comparatively rare, and has been in- dignantly frowned upon by every honourable phy- sician. Dr Johnson in his life of Dr. Garth, remarks: " Whether, what Temple says be true, that physicians have had more learning than the other faculties, I will not stay to inquire ; but I be- lieve every man has found in physicians great libe- rality and dignity of sentiment; very prompt effu- sion of munificence, and a willingness to exert a lucrative art where there is no hope of lucre"— and I trust and hope, Gentlemen, none of you will give cause to question the justness of this gratifying tribute to our professional character. What is the value of splendour or wealth, when gained at the expense of misery and tears! and contemptible must be that man who could enjoy luxury so unfeel- ingly obtained The relation which subsists between medical gentlemen is of the most delicate kind. Too much etiquette cannot be observed when it does not in- fringe upon the welfare of your patients. Never 17 forget your self-respect, if you wish to inspire re- spect in others; and the dignity of the profession can alone be sustained by a scrupulous attention to decorum and honour. Vain-boasting of cures inuendoes upon the practice of others, and insinua- ting methods to supercede them, may, and have met with success; but the high-minded and truly intellectual physician despises such chicaneries as unworthy himself and his profession. Whatever objections he may have to the practice of his breth- ren, is founded upon opinion, and is open, manly, and uncompromising. Let no consideration, Gen- tlemen, induce you to descend to such unbecoming means, to obtain practice ; for you will, in this man- ner, surely compromise your own character as well as your profession. I fear I have tired your patience, but I must ask your indulgence a few moments. I feel constrain- ed to point out to you a rock upon which many in- dividuals, who might otherwise have been useful and honourable members of their profession, have fallen and stranded. It is a painful and humiliating subject. The vice of drunkenness so awful and destructive in its ravages, has sometimes entered the portals of our sacred temple. It is of no con- sequence what may be your talents, acquirements, skill or virtues—once under the influence of this disgusting fice, and your usefulness is gone. The 18 suicidal act upon your reputation is committed, and you are morally dead. We have, likewise, been accused of want of re- ligion, and it has been a frequent source of regret among the human race, that a class of individuals who contribute so much to the alleviation of the sufferings of their fellow creatures, and acts of dis- interested benevolence, should be sceptical, as re- gards an after life. Even Napoleon, accustomed to all the horrors and carnage of war, in his last ill- ness, cast this terrible satire upon our profession. " J am neither," said this extraordinary man to his Priest, "a philosopher or a physician. I believe in God, and am of the religion of my father. It is not every body who can be an Atheist. I was born a Catholic, and will fulfil all the duties of the Ca- tholic Church, and receive the assistance which it administers." He then addressed his physician (who, it is but justice to say, denied the accusa- tion,) in this impressive language—" How can you carry it so far? Can you not believe in God, whose existence every thing proclaims, and in whom the greatest minds have believed i?" It is true that our professional avocations pre- vent our paying that attention to external religious exercises which we could wish ; but our Saviour's response to the Pharisees, is a full justification of us. It is, however, more lamentably true, that some 19 of our profession have attempted, from their ana- tomical and physiological investigations, to travel in unknowable regions, far beyond their ken, and presumptuously prescribe laws and draw infer- ences upon subjects which can be decided alone by the Almighty power who created us. But the great majority, and the more really sensible portion of our profession, I do not hesitate to say, possess as much genuine religion as any other class of men— the religion of the heart. If, there are any among you who have been induced to undervalue religion, believe me, you have fallen into a fatal error for your happiness as well as usefulness. The expe- rience in the course of your duties which you will have of the comfort it affords in the hours of af- fliction or death, will fully and forcibly convince you of its blessedness. It is the only refuge in those trying hours. No matter what may be your vir- tues, or the excellencies of your heart, a just sense of religion will make you wiser and better. But should you be sceptical, it would be unbecoming and indecent, nay inhuman to speak disrespectful- ly of what is so identified with the hopes and happiness of those who confide their lives in your hands. On this subject, however, it would be pre- sumptuous in me to enlarge. I have thus, Gentlemen, in conformity with the laws of the Medical Society, addressed you ; and 20 endeavoured to point out to you some of the duties of the physician. In all your proceedings, let me beseech you to have a steady and undeviating view to the elevation* dignity, and usefulness of your profession. Re- member how elevated its character in every age or country, or condition of men. Do nothing, therefore, which will compromise or lessen its value in the estimation of mankind. The institution with which you are connected, although young, has taken a high station among the medical institutions of our country. You must, therefore, always remember your alma mater; bear constantly in mind the maxim, that the tree is judged of by its fruits, and in proportion as you de- viate from the path of professional dignity and rectitude, you sully its character and standing. May prosperity and success await you. May you become useful members of the respective com- munities in which you may reside, as well as orna- ments and benefactors of your country; and may the blessings of Providence watch over and protect you. In behalf of the Medical Society and Col- lege, I bid you an affectionate and heartfelt fare- well.