W^ S^Jth^y al$&itto(j Mhhn TO THE J&iadiMz^wzw OF THE neai uriwiiif OF THE UNIVERSITY OF MAKYLAND, By Richard Mo Sherry, M. D. LECTURER OX MAT. MEDICA AND THERAPEUTICS. Delivered at the Holliday Street Theatre, March 7, 1863. PUBLISHED BY THE CLASS. 2$6X- £■ BALTIMORE: PRINTED BY W. M. INNES, AD1MS EXPRESS BUILDING. 1863. # ft Prof. R. McSherry— The "Medical Class" of the University of Maryland have imposed upon us, the pleasing task of requesting of you for publication, the man- uscript of your Valedictory Address. By complying with the above request, you will confer a lasting favor upon the class. We are, most Respectfully, Your obedient servants, Baltimore City, March 7,1863. \V. P. Smith, Wm. T. Urie, John H. Chew, W. T. Kemp, Arundel Hopkins, Committee. Baltimore, March 7, 1803. Gentlemen In reply to your polite note requesting a copy of my Valedictory Ad- dress to the graduating class of the University, I have only to say that it belongs to you, by right, and is therefore at your service. "Would it were worthier." Yours, with sincere regard, Richard McSherry, M. D. Me.«rs. Smith, Urie, Chew, Kemp and IIopeins, Committee. \ Medical Department, University of Maryland, March 7, 1863. Gentlemen : After drawing so heavily upon your patience during a long course of lectures, I would now be very reluctant to appear before you again, except under the conviction that the occasion will make you indulgent. But I may trust, that on this day, the humblest discourse will find its prosperity "in the ear of him that hears it," rather " than in the tongue of him that makes it." From this day, henceforth, we assume new relations towards each other. You and we, pupils and preceptors, hitherto, are now brethren enlisted in a common cause, engaged in the same pursuits, sharing the same labors. We have for you no more didactic instruction; we have brought before you our stores of knowledge, combining our own experience with that of the masters of our profession whether of the present or of past ages; we have poured out our treasures freely before you, and we have besought you to make them your own. Medicine is truly a liberal profession. By our universal code of ethics, the wise and learned physician of 4 every age and of every nation, makes known to his breth- ren whatever experience or research may have taught him is conducive to the common good. We have no secrets, no Eleusynian mysteries. It is a point of honor among physicians that any useful discovery made by one shall be passed over at once to the common treasury. We have a common treasury, in which every trained physician has an inalienable life interest. He can take from it whatso- ever he will ; but it is not for himself alone—it is for the good of mankind, under his special ministry. In consid- eration of this great privilege, he is bound to add to the common stock as he can, and this return, while it makes him no poorer, makes us all more rich. You have now within your reach all that Hippocrates, or Galen, or Har- vey, or Jenner, or Sydenham, or Physic, or Pare, or Dupuytren, or Bernard, or Louis, have brought by their diligence or genius, from darkness to light. You may look back from your studies of diseases which will occupy a very large proportion of your professional cares, to tbe great and good Laennec toiling in the Necker Hospital year after year to throw a strong, bright light over the path of professional labor to the end of time. All of these worthies, and thousands more, lay their gifts at your feet, and solicit you, as we have done, to use them. They ask no return of you, but future generations, as well as your fellow-laborers, who share with you the beat and burden of the day, have a right to ask that you hold back nothing which may benefit your brethren, or your race,—for all men have in this an interest: " Utcunque homo est, ibi heneficio locus," says Seneca, and the physician is expected to be a universal benefactor. 5 In what I shall proceed to say, there will be no longer the language of a preceptor to pupils, no more of the verba magistri ; tbe only claim to precedence now is, that which an elder may have over younger brothers, and thus only do I address you. I say that we have laboriously brought before you the treasures of professional know- ledge, which we have brought freely from every depart- ment of the treasury, and I am happy to add that on your part, you have gathered and gleaned with a diligent intelligence that does you credit now, and that indicates great promise in tbe future. You are now Doctors of Medicine, entitled to all the honors and all the emolu- ments attached to the title. It is to be hoped you have well considered what it is to be a Doctor of Medicine. It is to be an accredited mem- ber of a great fraternity which is much esteemed by society, which is tolerably well remunerated, which is very influential for good or for evil, and which has in charge no less a trust than that of the life and health of the human race. Tbe profession opens a boundless field for all your capacities. It embraces an aggregation of sciences, of learning, of art, and of wisdom. The o-reatest human intellect may find scope and occupation therein. No man can be too wise, too great, or too good, for its exigencies. There are those who think that tbe o-reatest intellects should be devoted to other pursuits, as to law, or theology, or statesmanship, or to tbe science of destruction, embodied in war. But if you analyze the sentiment, it only means that these lofty pursuits usually lead to places more conspicuous in the Temple of Fame ; it does not mean that the great science 6 of Medicine is not quite adequate to give life-occupation to the most exalted mind. Indeed the requirements are so great that very few men are equal to them. If you could distinguish among the denizens of earth the wisest of physicians, you would find him to be one of the wisest of men, and yet none would be more ready than himself to admit his insufficiency. I presume there is no living physician, great or small, who does not often deplore his own limited intelligence and limited abilities. In fact, the more he learns, the more he feels the want of that which he has not yet attained. It is only the blundering and criminal empiric who presumes that he has mastered medicine: "The truest characters of ignorance Are vanity, pride, and arrogance; As blind men use to bear their noses higher, Than those that have their eyes and sight entire," says one of tbe keenest of satirists. Tbe Doctor of Medicine, to be equal to his calling, should be a proficient in many sciences. Our very curriculum of studies keeps this fact constantly before you. He should be a man learned in the lore of present and of past ages. And here, I beg to say, many under- rate the teachings of the Fathers of Medicine. They think nothing worthy of study but tbe improvements and changes of modern medical progress. The experience of thousands of years with such is as naught. What you have learned from your preceptors and they from theirs, and so on back through medical history until we reach the remote ages of the Asclepiada3, of whom the wisest and best was Hip- pocrates, is all held by some to be chaff which must be 1 blown away by the breath of modern knowledge. I once beard an eminent Professor tell his class, of whom I was one, that so great was the progress of medicine, so thorough the revolution, that the aspirant to success must now throw away all he had learned, and start de novo, to acquire the first elements of medical knowledge. This was very dis- couraging to students looking for their degrees, and, con- vinced that they had acquired a good stock of medical lore. One might have said to himself in the language of a recent poet: ''Not in Hades alone, Does Sisyphus roll, ever frustrate, the stone, Do the Danaids ply, ever vainly, the sieve, Tasks as futile does earth to its denizens give." But in point of fact, tbe Professor was mistaken. There are medical precepts in the first books ever written, and even in those pages inscribed by Moses and Solomon, which are as sound and just to this day, as many others of tbe most recent origin. It is true we have lights now which our fathers had not; and we find in their systems many errors, but in them also, many facts which have withstood the test of ages, and which must endure to the end of time, because they are facts, because they are truths. We will then not throw away what is ancient because it is ancient; we will only reject that which proves to be untrue. It happens unfortunately that we are constantly tried with novelties, sometimes of meteoric brightness, which are not the more trustworthy for being more modern. Many of our brethren are too easily misled by novelties ; others are too slow in adopting real improvements. Physicians, for tbe most part, appear incredulous as to new theories, 8 whether true or false, and this has been made a reproach to them ; but the sentiment does not altogether merit reproach. If they were carried off by each new specious theory, it would be a great evil for those under their charge. It were better to be slow to recognize the circu- lation of the blood, tbe benefits of vaccination, of auscul- tation, or of anesthetic agents, than to accept them off- hand with a thousand crudities which each age brings forth under the pretence of progress. A certain degree of reserve in committing your faith is necessary to profes- sional conservatism, and to professional usefulness. Tbe profession is too enlightened not to accept truths which bear the tests of a many sided critical scrutiny—as witness the few great illustrations which have just been cited ; it is also too enlightened to adopt all tbe flitting theories which medical enthusiasts or medical impostors may attempt to palm upon the public, as new lights by which all must be guided. I am far from underrating progress, as you already know ; I only wish now to assert that such of us as are not great discoverers, may use all the lights trans- mitted by our predecessors, as did Harvey, and Jenner, and Laennec, and tbe other great men who have made discoveries which will rank among tbe truths of medicine to the end of time. Our modern doctor, then, should be a man of much learning ; well informed in the doctrines of the schools of the past and present times ; he should keep his eyes, too, upon tbe works of our professional pioneers, physi- ologists, pathologists, chemists, therapeutists, anatomists, and surgeons, for all are adding, day by day, to the stock of knowledge. Our standard works teach us what is 9 already accomplished ; our journals record the progress of discovery; and these are to be conned and collated, and measured, with unwearied diligence. " Nocturna versate rnanu, versate diurna," says Horace. By night and by day, you must pore over them. I suppose that you all aim at professional merit and pro- fessional success, (the one being a sure key to the other,) and thus I counsel you to pursue a life of study. Until you get into the ordinary current of professional labor, time will hang heavily on your hands, unless you find occupation. It is a saying of Lord Bacon's, that "a man's nature runs either to herbs or weeds ; therefore, let him seasonably water tbe one and destroy the other." The young physician may especially be mindful of this saying. If he loiter his unoccupied time away, his nature will run to weeds, but if he devote it to laudable improvement, precious herbs will assuredly spring up under bis careful cultivation. Study becomes tbe Doctor, and should be to him as a second nature; but yet, I am free to say, that book-lore alone, can never make a good physician. No other man can impart his knowledge to you, by word, or by writing, in its fullness. He may give indications, he may show you tbe way, be may impart easily to you something which he has acquired only by great labor, but there are certain faculties pertaining to discernment and judgment which are not transmissible. You can never be satisfied with the teachings of any master; you must examine, think, see, feel, and judge for your- selves. Tbe most minute recorded history of a disease, and the most detailed methods of treatment may be 2 10 acquired by the single faculty of memory, but you will soon find that this faculty is very far from being all- sufficient. And indeed, diseases though called by com- mon names, have as many shades of difference as you see in the leaves of trees, or in the human countenance,— general features in common, but special differences peculiar to each. The practical physician can distinguish points necessary to be distinguished, while the mere medical scholar, or book-worm, is lost in perplexity between things so like, and yet so unlike, the descrip- tions presented in books. Study and Practice, then, must go hand in hand to make, I will not say the perfect, but the respectable physician. You correct your readings at the bedside; you add other experiences to your own in your library. In this manner, in a few years, you become masters in your calling. But let there be no delusions. If you knew all the sciences, and possessed all the learning of all ages, and had the vastest fund of personal experience, you would still find your science, your learning, your experience, at times thoroughly baffled. As you cannot have all of these varied advantages, you may be sure that more moderate gifts will not save you from frequent disappoint- ments. You will often be mortified and distressed at your own want of success, and you will have to bear reproach, whether justly or unjustly. Your life, I may foretell you now, will be one of many trials. If it were only a life of great labor with very moderate compensa- tion, if it only involved fatigue of mind and body, weary rides, night-watches, irregular meals, and broken rest, it 11 • would be scarcely different from that of many of your fellow travelers, who earn their bread by labor, but it is far more than this. It is a life of fearful responsibility. I say, if you possessed the whole aggregate of human wisdom, your gift would often fail in the hour of need. No supernatural power would be yours, and yet such power appears to be sometimes unwisely expected. There will be suffering which no skill can mitigate; and death will claim bis own in spite of what you may deem the surest of remedies. These things must be so, so long as man's knowledge is finite, and his life is mortal. The life of every physician, if exposed to its depths, from beginning to end, would afford, in every sense, a curious history. There are his own trials and tbe trials of those with whom he spends bis days, and to whom he gives bis ministry, to make up its events. The poet says : "The pendulum of life vibrates between a smile and a tear." But medical experience scarcely finds things so happily balanced. The doctor spends bis life in the solace of misery, of sickness, and of suffering. He consequently sees more of tears than of smiles, and the condition of his race, as be finds it, is likely to impress his own character. He becomes necessarily grave and thoughtful. This is so true, that the thoughtless, and all who know not heavy cares, think tbe professional gravity of the doctor an affectation, a sort of counterfeit of, or substi- tute for, wisdom. Time will prove to you that this is an erroneous judgment. The doctor may be cheer- ful, and he should cultivate cheerfulness; but that gaiety which distinguishes the light-hearted, and those who 12 have no deep experiences in life's corroding cares and sorrows, can never be his. He has his own load of care to bear, and that of many of his confiding patients. In fact, the doctor, besides being medical adviser, is a uni- versal confidant. He is the receptacle of all sorts of family secrets, of all sorts of family cares. What is carefully hidden from all other men, is often entrusted to him as a matter of necessity; but beyond this, the ice being broken, people unbosom to him as a matter of choice. He must understand and appreciate this trust. He must guard it as sacredly as he does his own, or his family's honor; as he guards the honor of wife, of mother, or of child, of his own. Sometimes he may be wronged by those who, in the past, have given him their confidence. Even then he may not indemnify himself by breaking the trust once confided to him. With him there must be no breach of faith, though others fail to appreciate bis noble integrity. When advanced in your professional career, you will be weighed down with cares and anxieties. Earlier in life, you will have many obstacles to encounter. The young physician cannot command the public confidence ; before be gets this, be has to go through an ordeal of terrific criticism. The very want of confidence is a hindrance to his professional success. At all periods of life, he will find bis practice most successful where he commands most fully tbe confidence of his patients. This is acquired but slowly in the beginning ; after a time, it is more freely accorded. Yet. there are cases in .which, you cannot win it'., When you get to be gray-haired veterans, ripe in experience and knowledge, you will still be called to cases 13 where something shows you are not quite well received. You may attend such cases faithfully, skillfully, and suc- cessfully ; and yet between them and you there is some unexpressed and inexpressible want of concordance. You may get along with the bodily ailment well or ill, as the case may be; but there seems to be no sympathy struck between you and them,—no chords which vibrate in har- mony between tbe doctor and such patients. I do not pretend to explain the fact; I merely state it as such, and as, to me, one which is a psychological perplexity. It is never pleasant to attend such patients, whatever pecuniary compensation they may make. I have not heard other physicians speak of this strange want of sym- pathy between themselves and certain patients, but I do not doubt that all have the same experience. Such cases, however, are rare exceptions, and those who employ you, generally repose in you a satisfactory amount of confidence. But there are critics on every band to can- vass and decry your measures. Tbe bystanders are apt to censure you because of your youth and inexperience ; and older members of your own profession are apt to censure because of prospective rivalry. There are, happily, methods by which you may be sus- tained. Whatever you may have to do, however poor or obscure tbe subject, try to do well—to the best of your abilities. Watch diligently by the bedside, note tbe changes as they, occur, mark well the progress of disease, and the effects of remedies, study your cases Avhile you treat them in the best.authors, and then you may trust '■■■....' •» the.rest to God,—remembering always in the words of the wise man,' "For of the Most High, cometh healing." 14 Let your course be marked by conscientious diligence, and wholesome prudence: " Nullum numen abest, si sit jn-udentia,,'> says the Latin poet, and in none of earth's pursuits can prudence be better applied. Such course will bring the best and the wisest of the public critics to pass upon you a favorable sentence ; first promise, and next performance, will be accredited to you. The much needed confidence is sure to follow. If your brother doctors still prove ungenerous, teach them in your life a better lesson. Show them that you only hope to rise by honest merit; that you scorn to do them any wrong by act or deed ; but that if they will surpass you, it must be by qualification, not by empty criticisms. It were better for tbe honor of the profession, which is dear to us, that physicians should rather extol than con- demn each other. We have a field for noble rivalry where all may obtain honors, and it is far better for us all to contest for the palm of merit, than to leave it, or turn aside to wrangle over each other's demerits. When the competition is for knowledge and truth, all the competi- tors, first and last, are winners ; but when it is a mere personal tilt, one against tbe other, both parties are likely to be losers. Our field is truly immense. All the kingdoms of nature may be explored in the service of medicine. In tbe legiti- mate practice, we are not tied up, or tied down, by any specious or one-sided theories. If the simplest flower that grows by the road-side proves to be a valuable medicinal agent, no matter who first discovered its virtues, whether 15 learned botanist, or knavish charlatan, or decrepit old woman, or aboriginal brave, or medicine-man, we may, and we must, give it a place among our standard reme- dies. If medicinal agent come from the bottom of the sea, or from sea-weed, or sea-water, or from mountain top, or from deep mine in the bowels of the earth, or from chem- ist's laboratory, it is ours, at once and forever, so soon as its virtues are made manifest. Many of the instruments of science appear to be espe- cially adapted to the interests of medicine. Galvani and Volta played upon the electric wires, upon living and dead animal tissue, upon brain, and nerve, and muscle, before it was dreamed that these should carry winged messages over the face of tbe earth ; and still the battery is used with frequent success in the relief of human mal- adies. The microscope has opened almost a new world in the hidden mysteries of the living frame. This, com- bined with organic or animal chemistry, has yet to teach us wonders. The physician is at home in the various pursuits just indicated. He cannot, indeed, master a multiplicity of sciences while he attends to the daily routine of duty; but he can follow, though at some distance, the explora- tions of pioneers, and be can, often far better than they, bring their discoveries to practical uses : indeed, this, for the most part, is his work,—the application of discoveries to the needs of man. I must not make out, withal, that medicine is all care, all labor, all study, all drudgery. The profession has its pleasant features. The mariner is not always tempest- tossed, and the soldier is not always seeking reputation 16 " at the cannon's mouth " ; neither is the doctor always weighed down with care. As the general rule, success attends his measures. Medicine, indeed, hath its uncer- tainties, as have all things not stamped with Divine wis- dom ; but it is not so cloudy, so misty, so vague, so doubtful, as half-fledged criticism often declares it to be. Our sharpest critics sometimes change their tone when dire disease touches or threatens their own persons. " Physicians mend or end us, Secundum artem; but, although we sneer In health, when sick we call them to attend us, Without the least propensity to jeer," says Byron. It were a libel on tbe intelligence of the human race to assert that the researches and experience of most enlight- ened and most honest men, for thousands of years, have brought forth nothing reliable in the cure of human dis- ease. Our profession is enlightened, is honest, in the highest degree. The search for truth among our breth- ren is earnest, sincere, laborious,—I may say, magnifi- cent. This search has not been without fruit. Scattered grains of truth have been gathered in all ages and in all nations, until we have a heap of them more precious than precious stones. Surely no man will say the profession of medicine is deficient in general enlightenment. It is true, we have much to learn, and must ever have, because the field is boundless; it is equally true that we have learned much. The enlightened physician, then, has no supernatural gifts ; but he has a vast fund of knowledge which is useful in the cure and the relief of disease, and cure or relief usually follows his well-devised measures. 11 "Honor the physician, because he is indispensable, for the Most High has created him." " For all medicine is a gift from God." * * * * " The science of medicine shall elevate the physician to honor." * * * * " The Most High has created the medicines out of the earth, and he that is wise will not abhor them," says tbe great oracle of Hebrew wisdom. You may generally, I say, expect success to follow judicious treatment; and there is something beautiful and fascinating in watching the progress of restoration under skillful ministry. Moreover, you form the closest ties of friendship with your patients and their families. You become as one of them ; your cares, your watchings and labor, are often rewarded with deep and pure affection. This sympathy and friendship between tbe doctor and bis patients are of the sweetest fruits of our toilsome lives. I have spoken of much study as one of your obliga- tions. Now, by habit, study becomes pleasant, not irk- some. It need never be wearisome. One of the ablest and most brilliant of living litterateurs says that all of his study and writing is comprised within four hours a day. This is quite enough for a man of active pursuits to give to books ; and even to gain this, the working doctor will have to borrow from the night. He need burn no " mid- night oil," however, unless exceptionally, for some special purpose. You want a library, which, at the beginning, need not comprise more than forty or fifty choice, standard works on the various branches of medicine. You want one or two good medical journals, to keep you posted in the pro- 3 18 gress of the age. These will suffice for general instruc- tion, or for reference. You have already a good founda- tion to improve upon, though you have not passed through the forms of the ancient school of Salerno, where, according to the Golden Legend, " The first three years of the college course Are given to logic alone, as the source Of all that is noble, and wise, and true " ; a scholar asserting " That none but a clever dialectitian Can hope to become a great physician ; That has been settled long ago. ****** After this, there are five years more, Devoted wholly to medicine, With lectures on chirurgical lore, And dissections of the bodies of swine, As likest the human form divine." But, I say, you are well stored with the elements of modern medicine, being, myself, a witness to your dili- gence as students, and the fruits which it has already brought. You go forth, hence, from this temple of mimic life, to the great world abroad where all is stern reality. I have identified you throughout with the Doctor of Medicine, but you will have various other relations which must necessa- rily checker your lives with lights and shadows. Perhaps while I have been discoursing, you, fleeing in imagination from matter so dry, have seen the bright eyes which will illumine your path with a softer and sweeter light than that which radiates from lectures, and books, and schools. 19 Be it so. You will want their solace. Often when home- ward bound from the scenes of weary labor, your heart will be cheered by knowing that— "There is an eye that will mark, Our coming, and grow brighter as we come." But I will not trespass behind the scenes. Nor will I trespass longer upon your patience. I have only now to express for my distinguished colleagues and myself, our earnest wishes that full measures of success, honor, and prosperity may await your career as physi- cians and as men.