^O^H~^ IU./L THE VALUE OF A DIPLOMA. VALEDICTORY ADDRESS DELIVERED BEFORE THE cftical (Srakatrs of f atlmilr Inibcmtjj, AT THE MASSACHUSETTS MEDICAL COLLEGE IN BOSTON, Wednesday, March 7, 1860. By EDWARD H. CLARKE, M.D. BOSTON: DAVID CLAPP, PRINTER.... 184 WASHINGTON ST. MEDICAL AND SCBGICAL JOURNAL OFFICE. 1860. ADDRESS. Gentlemen, Graduates of the Medical Class : The gathering of any assembly, the perform- ance of any ceremony, inevitably suggests an inquiry into the reason of the gathering, into the meaning of the ceremony. The audience, which has listened to you to-day, raises the question of the reason of their coming here; the ceremony, in Avhich you ha\e taken so prominent a part, of itself propounds tHe question of its meaning and use. It Avould be a superficial answer to such inquiries, to say, that the audience of this hour came here to learn hoAV Avell or ill you can recite a medical essay, or to ascertain hoAV much or hoAV little your teachers haAre taught you, or hoAV much or hoAV little you have taught yourselves, of medicine. Equally superficial Avould it be to say that the ceremony, Avhich has just been enacted, the bestoAA'al of Diplomas upon you by the distinguished head of ]Ianard University, means that you haAe ended your medical studies, by receiv- ing a doctor's degree. There is a reason for the presence of this audi- ence— a real and substantial one — which, if you open your eyes to see it, reaches down to, and takes 4 hold of Avhatever is vital and true in your profession. There is a meaning in the ceremony of conferring a medical degree, and in the degree itself, Avhich, how- ever it may be hidden, hoAvever you may forget it, takqs hold of, and belongs to Avhatever is Avorthy and noble in the science and art of medicine. It is this reality, which, consciously or unconsciously, has drawn an audience here to-day, and not the mere curiosity of seeing hoAV a neAv-fledged doctor can flap his untried AAings; or of learning Avith how smooth a phrase, you can recite some of the mysteries of health and disease. It is this reality, that gives to the Diploma you have just received, its substantial value, and invests the simple ceremony of its bestoAval Avith a profound interest. It is because of the reality which attaches to medicine itself; because, in our social and providential order; in our Christian civili- zation and deArelopment; it is because medicine, in all these, has a substantial and most important place; because it is a vital thing, as much so as the church, or the school, or the press, that your Diploma has any worth, that this audience have come here to-day. It is because your profession is a reality, and not a sham. If this be so, your diploma is a sacred thing, and not a decoration, or a toy. It is a symbol of what is Avorth more than gold or silver. It carries with it a meaning, Avhose depth and breadth it Avould be well for you to explore and comprehend. It is invested with a nameless, but real virtue, Avhich should cause it to be sacredly cherished. I find, then, a sufficient theme for my brief address to you, in the parchment 5 which you hold in your hands ; in the diploma you have have just received; in the degree you ha\re just noAv taken. I have called your diploma symbolic of Avhatever is true and essential; of Avhatever is vital in your profession. It is so. It is significant of the fact that underlies the science of medicine, and justifies the existence of a medical class or profession. To consider a diploma from this point of vieAV would be to make it a text for discussing the value of medical science and art in our civilization, or in any possible civilization ; it Avould be to enter a plea in behalf of medicine, and, taking hold of the core and heart of the matter, to shoAV the absolute necessity of its existence. This Avould be a work of supererogation. For- tunately for you, I propose no such profound discus- sion. None doubt the necessity or value of medical science, or medical men, hoAvever much they may decry the one, or satirize the other. What I ask your attention to, as not inappropriate to this hour of your entrance into the medical communion, and of fareAvell to medical pupilage, and as not unworthy of your consideration, is a few thoughts, that natu- rally cluster about the insignia, that mark your cho- sen profession ; the flag, under Avhich you sail; the banner, Avhich you uphold. I select this subject the more willingly, because at the present time, and especially in this country, there is a growing tendency to disparage whatever marks any select body; to despise all titles, hoAvever nobly earned or honorably bestowed. Particularly is this true 6 of the title, by AA'hich you will henceforth be knoAvn, the unpretending one of Medicines Doctor. More- over, it is a title which you can never lay aside. Once having acquired it, it will stick to you through evil report and good report. You may become any- thing else you can—poet, lawyer, grocer, mechanic, statesman, politician, president—and you Avill find that the doctor never will leave you. Once receive a medical diploma, and the M.D. is printed on your skin, so legibly that all can read it, and branded in so deep, that no metamorphosis of tissue can erase it. It behooves you, then, to know Avell its meaning. There Avas a time, and that not long ago—I do not say that the present is not such a time—Avhen a Medi- cal Degree had an unquestioned value. But, if it has lost that value, if its significance and vitality have died out of it, let us carry it no longer. AAvay with Avhat is only a bauble, or a vain show. But, if there is virtue in it, if it rests on a fact, and is not a sham, then cherish it and wear it proudly. In reality, the only value which your Diploma possesses, now-a-days, consists in its intrinsic merits. No factitious charms, or talismanic powers, or mys- terious virtues, surround it. It derives no authority from laAv. Indeed, legislation has done its utmost to make it common, and deprive it of all external value. The butcher of Avhom you get your dinner, the cobbler that patches your well-worn shoes, the hostler that cleans the horse, your expectant fees are so soon to furnish you with, all, or any of these may write M.D. against their name, with none to forbid, or make them afraid. Fortunate, indeed, will you 7 be, AAherever you offer your senices to the Avaiting public, Avhether in city or Adllage, or in some distant Avestem clearing, if you do not find, in close proxi- mity to your modest and classic sign, some other as- pirant, masculine or feminine, for medical responsi- bilities and labors and fees, Avho (though altogether innocent of the slightest medical preparation) puts M.D. upon his or her card, with as bold a front as yourself. Yet the law extends no more protection to your substantial claim to a Doctor's title, than to the shadoAvy one of the Empiric. Under the JEgis of the law, both are alike valuable, or valueless. Le- gally, then, your Diploma is worth nothing. It gives to you no legal weight, invests you with no peculiar authority. So far as the laAv goes, you may as well burn your parchment, as keep it. But more than this, the law does not recognize any authority in the source from which your diploma comes. There is nothing in the laAv to prevent your neighbor, John Smith, from bestowing a diploma upon John Smith, Jr., and the latter may offer to kill and cure the sick, by its authority, without encountering any legal obstacle. In winning your diploma, therefore, you have gained something of real and substantial value, doubtless; but nothing which the law, in these re- formatory and democratic days, recognizes as autho- ritative. I have already intimated, that John Smith, or John Brown, or any other equally eminent man, may sell or give a diploma, and commit no legal offence. In fact, the country swarms with Schools, Colleges, and Institutions of every name and grade, that manufac- 8 ture degrees by the wholesale, and grant them for the asking. This may be an unwelcome statement, but it is nevertheless true. You may as Avell look the fact in the face, for you must accept it. Through- out the length and breadth of our land, and not only in large cities, the great centres of population and business, of education and science, but in small vil- lages, and on mountain-tops, and in prairie wilder- nesses, there are schools of all sorts—Regular, I am sorry to say, as Avell as Irregular, Botanic, Homceo-' pathic, Mesmeric, Eclectic, Spiritual, and I know not of what other names—that yearly bestow thou- sands of medical diplomas, upon as many grateful recipients. Mark you, I do not say that all these diplomas, so lavishly given away, are equally valua- ble ; I only say that a diploma, without regard to its intrinsic merits, can be as easily got as sheepskin. It is no more difficult to get merely the title of Dr. than of Captain; and as many obtain one as the other, and with as good a right. And thus it happens, in this country, that while the law gives to the parchment you hold no authori- ty, or intrinsic worth, neither can you claim for it any value, because a degree of M.D. is rare, or ob- tained with difficulty. Whatever importance it car- ries with it, belongs to it, apart from any legal enact- ment or difficulty of acquisition. More than this, you must not expect that the possession of a degree Avill add anything to the estimation in Avhich you are held by a certain portion, and that a large one, of the community, even in your capacity as a guide for the sick. Indeed, there are those, and you will meet 9 aa ith many such, who will hold you disqualified to take care of and treat diseases, simply because you have sought, and earned, and Avon a diploma from a respectable source. I do not Avish to exaggerate the matter, and I do not think I do, Avhen I tell you, honestly and soberly, that the degree of M.I), not only does not, of itself, give to you any legal authority, or position, but it may he so easily got, as to carry Avith it no moral force, and even when obtained from the best sources, may be an impediment in the Avay of getting AAThat you all are anxious for, business. If all this is truth, and not fancy, Avhat is the value, and Avhat the use of a degree % This is the inquiry Avith which I started, and Avhich I propose to ansAver. I have already hinted that it has a substantial value. In reality it possesses a vital significance. It has a real place, and is worth all the labor you have spent in winning it; and this, too, apart from its signifi- cance as the symbol of a profession, Avhich meets one of the great wants, one of the primal and ever- present necessities of humanity. If you only look deep enough, you Avill see that the circumstances I have just mentioned, Avhich seem to discredit and depreciate a diploma, are really testi- monies to its worth. The laAv does not protect that which is able to protect itself. Whether this is good policy or not, whether it is for the best good of pa, tients who are physicked, as well for the doctors Avho physic, I will not stop to inquire. But the fact that a diploma has any value, in the midst of this free trade in doctors, is no slight tribute to the worth of 2 10 your parchment. Again, schools and corporations Avould not be giving aAvay so many bushels of coun- terfeit degrees, unless the article, Avhich they counter- feit, was, some how or other, held in estimation. Only the bills of unbroken banks are worth counterfeiting. Only the notes of solid merchants are Avorth forging. Only what is good in literature or art, in business or politics, is wrorth imitating. Even the Autocrat of the Breakfast Table cannot scatter the rich jeAvels of his Avit and humor, broadcast over the Avorld, with- out democrats of the tea table testifying, by their travesties, to the ring of the true metal, Avhich he dispenses. Charlatans of every hue, who deceive and dose the public, would not write M.D. against their name, or implore degrees from hybrid col- leges, unless there Avas a substantial value in the real title. The value and meaning, then, of a Diploma, Avhat are they 1 If a degree is not merely a relic of the past, the badge of a Avorn-out caste ; if it is not a hol- Ioav shell, out of Avhich the heart has been eaten; if it possesses a Aital significance ; if the parchment in your hands carries Avith it a substantial value, it is Avell for you to see, and recognize its Avorth. I have already intimated, that much of its value comes from its being the symbol, the flag of the medical profession, and that I do not propose to urge the acknoAArledged and necessary claims of that pro- fession. Beyond this, your degree is of great worth, because it confers on you privileges, that are not the less real and honorable from not being upheld by laAv; and because it imposes upon you obligations 11 and responsibilities, duties and restraints, that are none the less binding, from the fact that nothing but your honor as a man, and your faith as a christian, engages you to their exact performance. Can there be higher sanctions 1 A medical Diploma, supposing, always, that you have the real article, and not the counterfeit (I need not point out to you the difference betAveen the true and false), admits you into an honorable body, Avhich forms a republic, by itself, of brethren that do not recognize the distinctions of nation or government, of race or sect; AA'hose antiquity goes back to the mythical period of the human race ; and Avhich, com- ing doAAn the centuries through the mysteries of Egypt, the Eleusinia of Greece, the culture and pride of Rome, the mingled darkness and light of the middle ages into the larger civilization of to-day, extends OArer the aa hole Avorld; and embraces, in its list of heroes and sages, some of the profoundest intellects, and largest hearts and noblest men, philanthropists, scholars, and martyrs, that the Avorld has ever seen. Is it no privilege to be enrolled as the colleagues, or successors of such men ? to so stand, that the faint- est shadow of their lives may fall upon you X to be placed Avithin the reach of the lightest breath of their enthusiasm and then devotion 1 If you do not esteem this a privilege, you are unworthy of your diploma, and God forbid that you should be called a physician. Another privilege, which your diploma confers upon you, is that it gives you, not the legal right to practise physic, as it is termed—every blacksmith or 12 pedlar, barber or charlatan, has that legal right as much as you—but it giAres you a substantial and ad- mitted claim to the confidence of the better, and most trustworthy, and most intelligent portion of the com- munity. Wherever you may go, you Avill be sup- posed, in virtue of that diploma, to be at least an honest man, until, dishonoring the flag you carry, you prove yourself a dishonest one. And let me tell you, that this is no slight privilege, no small matter. Aside from all nobler considerations, and looking at the policy of the matter, it may not enhance your immediate interests to be known beforehand as an honest practitioner, Avho escheAVS all subterfuges ; but in the long run, you may rest assured that to be so considered, Avill be for the best interest of your pock- et, as well as your reputation and your conscience. These are privileges, both honorary and substan- tial, Avhich your diploma confers upon you. But look a little closer at it for a moment. While it con- fers privileges, it lays upon you obligations and re- straints. It puts upon you responsibilities, Avhich you cannot shirk, and binds around you restraints, Avhich you cannot break, at least not until you have broken your honor aud throAvn away your conscience. It is all important that you should see these re- sponsibilities and restraints clearly, and accept them fully. For if you are false to them, you are not only false to yourself, but to the University Avhich has graduated you, and to the profession Avhich it is noAv your privilege to enter, and to the community which it Avill be your duty to serve. Your diploma describes each one of you as — 13 " Yir, ingenio bono ac scicntia utili prseditus, mori- busque probis ornatus---qui ad Doctoris gradum admittatur." AYhich, by a someAAiiat free transla- tion, may be rendered a regularly educated physician. Educated; in that statement or certificate of educa- tion lies one of your chief responsibilities. Yet, Avhen the Faculty of the Medical Department of Harvard University and its President affixed their signatures to that statement, they did not intend to certify that you knoAv all, that is necessary to render you accomplished practitioners ; that you haAre attain- ed the culminating point of medical knoAvledge ; that you have received, digested and assimilated the Avhole science of medicine ; that you are in fact its latest re- sult, its exhaustive product. They do not certify to this. Still your diploma, properly and rightfully calls you educated. Meaning by that expression, that you haA'e received, not the maximum of medical knoAv- ledge, but the minimum, with which it is safe for you to go out into the community, as guides for the sick, and protectors of individual or public health. Less than Avhat you knoAv, Avould render you unsafe practi- tioners, blind guides. Heaven knows hoAV many such there are now. To authorize you to practise your art with less knoAvledge than you possess, would be unfaithfulness on the part of the College; not to in- crease that knowledge, Avill be unfaithfulness and injustice on your part. The more you can add to your store, the better for you and your patients. Herein, then, is one of the chief responsibilities, that of educating yoursehes, which your diploma imposes upon you. At present, you have learnt only the 14 alphabet of your profession. Now you are to use that alphabet in your own studies. Hitherto you have been under teachers; noAV you are to teach yourselves. The recorded experience of more than thirty centuries looks up to you. You are to master it, and add to it, by your own study and experience and observation. Your diploma does not mean that your education has ended, but that it has just begun; that you have learned just enough to be safe practi- tioners—nothing more. But inasmuch as you are called educated, your honor is engaged to carry your education on. Each day and week and month and year of your life, hoAvever and Avherever you may toil, is to witness your constant, unceasing, and un- wearying efforts to enlarge the education you have begun here. While your diploma privileges you to enrol yourselves with men like BoerhaaATe, Harvey, Sydenham, Mocller, Louis, and a host of others, it does not imply that you know all they know, but it does imply that you will strain every nerve, to render yourselves Avorthy of being put in the same catalogue Avith them. Your diploma certifies that you have begun the education of a regular physician. Your honor and faith are now pledged to complete that education. By virtue of your diploma you are not only styled educated, but regularly educated. This is a common phrase. It will be often used to distinguish you from other practitioners. Sometimes it Avill be applied to you as a reproach, and sometimes as an honor. WThen properly understood, Avhen understood in the sense your diploma uses it, it is expressive of the highest 15 merit. It does not refer to the form of your education, so much as to its spirit; not so much to its mode, as to its substance. Your education has been regular, i. e. normal, healthy. You have not only gone through a certain curriculum of study, such as experience has shoAvn to be the most advantageous, but in pursuing your studies, you have been taught, more than anything else, to regard yourselves as seekers after truth. Your instructors have not trained you into the ranks of a sect. They have bound you by no medical creed. So far as they Avere able, they have taught you truth. And noAV, as you leave their guidance, they ask you to folioav them, only so far as they have followed the truth. It is in this spirit, that all the great masters of medicine have lived and AATought and died. It is in this spirit, that you are to pursue your future studies. Whatever is true in Physiology and Pathology and Therapeutics, you are to look for and accept, Avherever it may come from, and whatever it may be. This is the animus of a regularly-educated physician. Whenever you de- part from this, permitting yourselves to be the slaves of a theory, or a creed, or of mere routine, you be- come irregular, you go over to the ranks of Charla- tanism ; and especially, if for the sake of winning popularity, or gaining notoriety, or filling your pock- ets with larger fees, you desert this broad platform, Avhich is the only support of true and rational medi- cine, you will imprint an indelible stain on your di- ploma. You will be false to the spirit of your pro- fession ; you avlQ be guilty of the blackest treason, because you will be disloyal to truth. 16 Milton, in one of the noblest passages of his prose AArritings, describes Truth as a being, AA'hich avus sent into this Avorld, complete and perfect in every part, resplendent in beauty, of noble mien, and of com- manding and winning aspect. By the rude discords and ill treatment of men, she Avas broken to pieces, and her mutilated limbs scattered to the four Avinds of heaAen. Since that sad catastrophe, mankind have been trying to pick out from the rubbish and dirt, the disjointed and broken pieces, so as to restore Truth to her pristine beauty. In this great duty of seeking and preserving the least remnant of truth, so as to add to the stock which every age collects, you are to do your part, hovvever humble that part may be. Only in your seeking, you must learn not to mistake error for its opposite, and abo\Te all, not to pick up a lie, hoAvever fashionable that lie may be, and cling to it, carrying it Avith you, making your living out of it, and all the time pretend that you have got a bit of truth. Your diploma, in declaring you to be regularly- educated physicians, not only proclaims that you commenced your education under teachers, that bade you own no master but truth, and imposes on you the obligation of continuing your education Avith an equally lofty aim, but it lays upon you the duty of practising the art of medicine, with the most rigid regard to the claims of right and honesty. The spi- rit, which dictates your studies, is to preside over your practice. The distinction, AA'hich your diploma con- fers on you, of being a regular practitioner, you are never to forfeit by any irregularity. And here, regu- 17 lar means honest and true ; irregular, means dishon- esty and deception. The line, which separates the regular practitioner from the charlatan, is not necessarily drawn by the possession of a diploma. A practitioner, Avho may have his name inscribed among the medical gradu- ates of Cambridge, Paris, London or Yienna, may prove himself to be, in charlatanism, the rival of Paracelsus or Morison. But in so doing, he forfeits all right to the possession of a diploma. So long as you hold your degree, you are bound to keep Avithin the strictest limits of integrity and honesty. Your diploma forbids your claiming any mysterious virtues for your peculiar modes of practice ; for the drugs you exhibit; for anything Avhich you haAre to do, either among your ignorant, or your intelligent patients; and aboA-e all, it forbids you to trifle Avith the sacred science, Avhose servant you are, and Avhose remedial agents you employ, by ever claiming for her a super- stitious reverence, Avhich is not her due, or poAvers which she does not possess. The age of mystery and superstition, of talismans and occult agencies, of necromancy and juggling practices, has passed away from regular medicine. You have no more to do with them, than saints with the devil; than priests Avith the black art. Wherever you lack knoAvledge, you may wisely confess your ignorance. AYhencver you are at fault, you may safely tell your patients that you are so, and they Avill think none the Avorse of your ability for so honest a statement. But your diploma forbids the concealment of your ignorance, by a mysterious claim of Avisdom. I speak of 3 18 this particularly, because herein lies your strongest temptation. It is so easy to assume the oavI's look of wisdom, by Avhich to deceive some Aveak-minded patient, that you may be tempted to do it. Frequent are the occasions, Avhen, prescribing some simple ap- plication, perhaps like that which the prophet of old prescribed for the Syrian Prince, " wash and be clean," you will be tempted to claim for it some ex- traordinary efficacy, to shroud it Avith some mysteri- ous virtue. Never do it. Your diploma forbids it. It may happen, that circumstances will enable you to steal into the confidence of patients by insinua- tions against some brother practitioner, possibly a rival; or to acquire business by means, not glaringly reprehensible, yet exceptionable; or to do, or say, by word or look, in the sick-room, that, which, if a bro- ther practitioner Avere present, you Avould leave un- done or unsaid ; or in some way, to swerve, for the sake of gain, from the straight path of honesty. Never do it. Never dally with the temptation a mo- ment. You cease to be a regular physician, when you do. You become a charlatan. Your diploma should be burned. There is one obligation, Avhich is implied by the language of your diploma, and the spirit of your pro- fession, which I wish not to leave unnoticed. Per- haps I shall come the nearest to my meaning, if I call it courage. You are to be brave men; brave, in the highest and noblest sense ; brave, morally and physically. And I thank God, that hoAvever else the profession to which I belong may have failed; how- ever derelict any or all of them may have been, in 19 other matters, in this respect they have been loyal and true. You must go a great Avay to find a phy- sician, Avho shrinks from his professional duty, however unremunerative, disgusting, dangerous, or appalling it may be. To this high ideal, your di- ploma, the standard of your profession, calls you to be loyal. Wherever sickness shows its most terrible form ; Avhere disease riots ; where contagion and pestilence stalk abroad, there is your post. Death, Avhatever mask he Avears, is to have no terror for you. I do not mean that you are to court oppor- tunities of danger; but that you are never to shrink from any professional duty. No human being can be so degraded, or cursed Avith a disease so loathsome or fearful, that you can ever refuse to administer to him the succors of medical art. And if your select- ed post of duty, where you hold yourselves in readi- ness to act as high priests of the sacred art of heal- ing, is ever visited by pestilence, or by unknoAvn and terrible forms of disease, all others may flee from it, but you must remain, even though it be at the sacri- fice of your lives. If you die then, you will die bravely in your harness, amidst the sick and dying you are ministering to. You may die, but you have no right to desert—to preserve an ignoble life by flight. It is the time, when, of all others, the com- munity have the strongest claim on your services. When the storm rages most fiercely, when the dan- ger is most imminent, Avhen the elements conspire to destroy, then is the mariner most needed. The pas- sengers must be saved, even if the officers perish. Such is something of the value and meaning of a 20 Diploma. It is no mere decoration ; no bauble. It is the symbol and standard of a profession, Avhich you cannot estimate too highly. It is significant of all that is vital and true and noble in that profession. It is conferred upon you by those, who, when they give it, charge you never to act, or be, unworthy of it. It enrols you in the ranks of a long list of noble men, of every age and nation, making you the de- scendants of heroes and sages. It presents you Avith the confidence of the community, and declares that you will be worthy of confidence. It engages for you that your industry shall be commensurate with your strength; that your honor shall be above re- proach ; your honesty unquestioned; and your devo- tion to duty, bounded only by your opportunities. Like knights of old, you go forth to shovv your prow- ess in the battle of life. The world is " all before you," where to choose your place—not of rest, but of toil. You have gained your spurs. They are clean and bright. See to it, that you never tarnish them. And so I bid you farewell.