;") / •>• / t /%<#. cx^. *L *C~ ^ L>< 1 t^^a^rff&tP, 4 ', - *-'^,*„"',1 »t Itotal Cbarattar »f Ibt gttbitstl profession. % AN ADDRESS INTRODUCTORY TO THE COURSE OF PUBLIC LECTURES 1 NEW. YORK MEDICAL COLLEGE, f SESSION OF 1852-3, BY E. R. PEASLEE, A. M., M. D., PROFESSOR OF PHYSIOLOGY AND PATHOLOQT IN NEW YORK MEDICAL COLLEGE. &* *-. PUBLISHED BY THE CLASSE- S' if NEW YORK: I5AKER, GODWIN & CO., PRINTERS CORNER NASSAU AND srRUCE STREETS. 1852. HmffiftMRBR Wit ggtml Ctaritr jf % lAiral Inrftssion. AN ADDRESS INTRODUCTORY TO THE COURSE OF PUBLIC LECTURES NEW YORK MEDICAL COLLEGE, SESSION OF 1852-3, BY E. R. PEASLEE, A. M., M. D., PROFESSOR OF PHYSIOLOGY AND PATHOLOGY IN NEW YORK MEDICAL COLLEGB. PUBLISHED BY THE CLASS. NEW 1:0KK: BAKER, GODWIN & CO., PRINTER^ CORNER NASSAU AND SPRUCE STREETS. 1852. ADDRESS. Mr. President and Gentlemen : I would gladly select for the present occasion, a theme which, while it may interest the medical gentlemen present, may not prove wholly uninteresting to those others whom we are happy here this evening to greet; and I have hoped that some thoughts upon the moral character of the medical profession, may not be deemed inap- propriate. And, in order to avoid all misunderstanding, allow me at first to define certain terms and expressions which I shall have occasion to ii such term. It was bestowed by an exclusive sect, in order to give the impression to the uninitiated that the regular practice of medicine is also based upon some exclusive dogma, like itself, and secure for itself some degree of comparative respectability ; and should, therefore, by every practitioner of medicine, be repu- diated. The word " physician" was also originally synonymous with " practitioner of medicine," and implied a knowledge of all the natural laws of the human economy, both in health and disease, and of the various means of curing or relieving the latter. It has now, how- ever, become nearly synonymous with "doctor;" this originally indi- cating extensive learning; but being now-a-days applied indiscrimi- nately t«> the scientific practitioner, and the most ignorant pretender to medical skill. To make tin- word " physician," therefore, any longer distinctive, we must say regular physician, or scientific physician, on the one hand; and irregular physician, homaopathic physician, &c, on the other. I shall use the word "physician" in its original sense, to mean a " regular practitioner"—a practitioner of medicine. The word '• doctor " will be u>ed as a mere prefix, if at all; and "doctoring" should be allowed at once to become obsolete—since, though often used to indicate the practice of medicine, it has at length become one of the meanest terms in our language, from its application also to the variou- methods of irregular practice. A fjo.nck is a practitioner—whether regular or irregular—who either intentionally makes his own interest his first concern, and his patient's welfare a secondary consideration ; or who ignorantly uses methods of practice not sanctioned by the experience of the profession. and which are either inert or injurious. It is true, that this latter class usually manifests the characteristics of the former also. Dr. Dar- win us.d to say, " a quack prescribes for the patient, while a phgni-Aan prescribes tbr the disease." But we may not forget that even the skillful, and in other regards, respectable practitioner, who makes a o useless parade of his instruments or of operative manipulations— who " does things for effect" in the sick room, in conversations with his patient's friends, or through the newspapers—is so far adopting the very methods from which quackery derives its main support. I now proceed to furnish some of the elements for a comparison of the moral character of the medical profession, as just defined, with that of the other learned professions. I. And, certainly, there is no human employment which, more than the practice of medicine, constantly needs the controlling influ- ence of high moral principle. The physician must be constantly assuming the responsibility of cases in which life must apparently depend upon the care and attention he bestows upon them, and in which, nevertheless, should death even occur from his carelessness or neglect, no human being perhaps might ever know or even suspect it. What a fearful responsibility is this! And how shall any but the most conscientious, and in all respects moral man, be prepared to assume it ? An old writer has said in regard to quacks in our pro- fession, " Lucky fellows they, since their successful cases are trumpeted to the four winds, while the earth covers up their failures." But would any one but a quack—but one of the most unprincipled of men— take advantage of such a fact ? The best that can be done is none too good for a diseased fellow-creature intrusted to our care ; and we vir- tually promise by assuming that care, to do the best for him that in us lies. If we know we must come short of this, from pressure of business or any other reason, we are bound to excuse ourselves if pos- sible from taking charge of the case at all, and let another do it justice. NVe have no right to neglect a pauper in order to attend to a prince; and, however great the temptation might be, we should possess moral principle enough to enable us to resist it. Let Hecquet be our model in this respect. He declined to see any more patients than he could properly attend to ; and, having at last waited on a lady of rank, who had repeatedly in vain requested his attendance, he was greeted by her, assuming an air of consequence which sometimes operates quite powerfully upon weak minds, with the following remark : " So, sir, one may have you for their money, like the rest of your brethren." ■' Madam," replied he, " your money may serve to maintain your servants and your horses, but all your wealth is not sufficient to recompense my skill." And the influence of the highest moral principle is constantly G needed in our relations to our professional brethren, as well as with our patients. In no other profession are the consequences of a want of it, so deeply felt; in none other will silence, where commendation is expected, or faint praise, when the speaker feels obliged to say some- thing, so deeply injure a professional brother, as in our own. And in no other profession is it so difficult for a strictly honorable and high-minded professional brother at all times to seem to do right, while actually doing so. So much the more necessary is it, therefore, that every physician possess that high sense of honor and that integ- rity, which will be a warrant of his honorable conduct, though ap- pearances may, through the officiousness and loquacity of others, be for a moment against him. Dr. Cheyne may serve as our model in this respect; who, when obliged by ill health to retire from business, received an address from a large number of his professional brethren, regretting they would no longer have him in their midst as a model of professional intercourse. Physicians are also called upon to exercise these high moral prin- ciples at all times and in all places. Other professional men have their hours of relaxation, during which they may be sure their great principles of action are not to be tested. The physician may be call- ed upon at any moment to exercise the highest moral attributes—his sense of honor, his benevolence, kindness, or sympathy—his forti- tude, firmness, patience, or presence of mind. There is no employ- ment, indeed, in which the moral and the intellectual faculties are so incessantly exercised, as in the practice of medicine. Is there, there- fore, any moment when the physician may be disguised or confused by wine, or by excesses of any kind ? I shall not forget the feeling account by a lady, of her own escape from death, by the spontaneous cessation of an alarming hemorrhage; while her physician, summoned late at night, and having arrived in such a state of intoxication as to be utterly incapable of rendering any professional aid, was heavily sleeping off his stupor in an adjoining apartment for the first two long hours after his arrival. Nor say that such an instance must have been in the lower ranks of our profession, and of life. The pa- tient was all that a splendid intellect, a finished education, a high rank in society, and all the incidents of a large fortune can render a young wife and mother; and the physician, I am sorry to add, was extensively patronized by others of a high position in society. Such an instance, I very well know, is almost unheard of in our profession. 7 But a single one, may well make every medical man, and every stu- dent shudder at the idea of voluntarily incurring any risk of forming a habit which, while it stultifies the brightest intellect, and brutalizes the noblest heart, may in a moment, and when we least of all expect it, make us accountable for the death, produced by our negligence or incapacity, of a trusting fellow-being. I cannot better illustrate the necessity of certain particular moral attributes in the practice of medicine, than by the following passage from the London Medical Times.* " The patience and temper of the medical practitioner are continu- ally tried by the fretfulness of illness, by the monotony of iterated com- plaint, by the garrulity of age, by the childishness of imbecility, by the impertinence of the vulgar, the curiosity of the idle, the pre- judice of the ignorant. His equanimity is invaded by the anxieties, the misgivings, the despondency, the agitation of those who suffer, and of those who are interested in them. His presence of mind and self-dependence, are severely tested by sudden changes, startling emergencies, and fearful perturbations; by the casualty which crushes manhood in its prime of vigor and usefulness; the attempted suicide; the mental tempest and moral wreck of madness. His fortitude, and confidence in his own art, are sternly taxed bv the fre- quent frustration of his best and wisest efforts. His cheerfulness and tranquillity of mind are overcast by the clouds of sorrow, by the dull night of hopelessness, and the shadow of the tomb settling on all around him. Amid all these troubles and contingencies he must stand unshaken, yet sympathizing; serene and gentle, yet active, authoritative and energetic ; anxious, and often perplexed himself, yet guiding others in their perplexity, and cheering them in their despondency—himself too heavily laden, yet aiding others to sustain their burden." Is there not a moral sublimity in such a relation to our fellow men, which no other relation or profession affords \ And how shall any but the highest development of the moral faculties attain to it! I will add a single other reason for the necessitv of the highest moral excellence in medical men. They are brought more nearly into contact with other minds than any other class of men, and must necessarily be more confided in, from the very nature of the case. The physician is often intrusted with secrets, on which the peace of *Dec, 1S30. 8 families and the welfare indeed of the community may depend. Kven the priest is not comparable with him, in this respect. And m an unprincipled man—a man of a mean and selfish heart-res- pond to, and deserve such confidence? But the very contact to which I have alluded, also makes apparent to others, a defect in moral cha- racter ; and hence a higher standard in certain respects, is actually required in physicians by the community generally, as will be seen in another part of this address. Thus physicians are required to pass an ordeal to which no other class of men, to the same extent, submit. But it should be so; and he that is found wanting is rightly rejected in due time, as unfit for the high duties of the practitioner of medicine. II. But the very circumstances in the practice of our art, which require the highest moral qualities, also tend to develop and perfect them. Indeed the mere study and practice of medicine, independently of anv such neces-itv, develop our highest moral faculties and feel- ings. I will here adduce the testimony of a learned divine :* " Let me say of this high and honorable calling (the practice of medicine), that it is second in importance and dignity only to the sacred minis- try of the Gospel and the church of Christ. It shares with us the best opportunities of seeing and knowing the wisdom, goodness, and power of God, in that ' we are so fearfully and wonderfully made,' and in all the mystery of life and of death. It is brought with us into cl( »e, familiar, and endearing contact, with many and affecting scenes of sorrow and of suffering, well calculated to draw out the finer feelings and tenderest sympathies of our common nature, and it is called with us to tread with silent, solemn, step, ' The chamber where the good man meets his fate, Privileged beyond the common walks of virtuous life, Quite on the verge of Heaven,'— and there may see, appreciate and admire, the power and consola- tion of religion in the weary hours of sickness, and on the bed of death. If the poet said with truth, ' An undevout astronomer is mad,' then how sad, how strange the anomaly of one well taught in all the laws and mysteries of human life, disease and death, and ever conversant with scenes of sorrow and of suffering, and with the need and power of Christian faith and hope, and yet careless, undevout and unbelieving." Such anpmalies are, however, in my own opinion, comparatively uncommon in our profession. * The Rev. Dr. Van Kleeck. 9 The ennobling influences of our art and science upon medical men has, indeed, been recognized at all times. Cicero remarks, that " Men are in nothing more Godlike than in giving health to men." Pliny also speaks of medicine as of divine origin. Moreover, the personal estimation in which physicians have ever been held, as a class, is significant in this connection: " Honor a physician with the honor due unto him," is the commencement of the 38th chapter of E> - siasticus; and even the Apostle Paul alludes to one of the Evan- gelists as " the beloved physician," in one of his epistles.* Cuvier remarked of medicine, that "it is the most extensive of sciences, the most useful of arts, and its pursuit the most worthy of a man whose heart is animated with the love of his fellow beings." And to the assertion sometimes made, that the studies and employ- ments of the physician naturally deaden his sympathies, I will merely reply for the present, that some men are so utterly destitute of any but selfish feelings, that even the study and the practice of medicine cannot develop any human sympathies within their breasts; and that unfortunately some such, now and then, get into the medical profes- sion. But no more should we regard a want of sympathy in a phy- sician as the legitimate result of his peculiar pursuits, than we should reo-ard any unchristian conduct in a clergyman as the natural result of his piety. Every profession has its selfish and unfeeling, as well as its benevolent men; and ours is the last to be accused, as will appear, of a superabundance of the former. III. I next proceed to show what moral attributes do actually characterize medical men as a profession. Dr. Johnson, in his life of Garth, remarks, " I believe every man has found in physicians great liberality and dignity of sentiment; very prompt effusions of benefi- cence, and willingness to exert a lucrative art where there is no hope of lucre." De Quincy also says, " The fact is, that the medical pro- fession composes the most liberal body of men among us."+ I will here allude especially to their self-sacrificing humanity. At any moment, by night or by day, they respond with alacrity to the call of Mift'ering and disease; and this often without any expectation of fee or reward, and often when more unwell themselves than those they visit. None but medical men have any idea of the amount of gratui- tous labour charitably performed by them, and to which the charit- able efforts of no other class of men bearf any proportion; for physi- cians never boast of this, and none others interest themselves to * Colossians. t Eclectic Review, Aug., IS47, p. 503, note. 10 acquire anv information on this subject. I am happy, however, to be able to quote exceptions to this last remark from the clerical profes- sion. ' After much reflection," says a Christian minister,* " I am settle ' in the conviction, that more gratuitous labor is performed by physicians than by any other class in the comniuuity. The percent- age of their unrequited labor is very large. Why should it be so? Their time, their strength, and their skill, aie their own. Neverthe- less, much of their time, strength, and skill, are given away." He also adds, that the physician's services are of such a kind that they would remain unrequited in reality, even though all pecuniary con- siderations are satisfied. " When in the struggle with disease," con- tinues he, "they find their efforts baffled, what shall we say of this wear and tear of sensibility and feeling? Will a few dollars and cents cancel such debts ? They are not canceled—they never can be /" This tribute to our profession very appropriately comes from that other, whose membeis generally expect our services shall be gratui- tously rendered to themselves and families. And I am happy to say- that while some/i'W patronize the various forms of quackery, this is not true (as has been sometimes said) of the clerical profession gene- rally ; and that the greatest and best men in it have been ever free to recognize the merits of the medical profession. Says the Rev. Dr. Putnam, " Unless I have been singularly fortunate in my medical associations, physicians, as a class, are rather remarkable for humane feelings and tender sympathies. There are among them, certainly, as many men whom I love and revere for all that is exalted and beautiful in human character, as in my own profession, or any pro- fession or calling whatever." In farther proof of the humanity and the charitable offices of physicians, I should add that almost all the charitable institutions, in this and other civilized countries, pay their medical attendants absolutely nothing for their services. Many, indeed most, of the hospitals are founded through the exertions of medical men, and are attended by them gratuitously; and yet it very often appears that medical men are, nevertheless, systematically excluded from the management of their internal arrangements; and thus their charitable efforts are, in great measure, frustrated by the ignorance and obstinacy of non-medical committees and trustees. And need I speak of the immense sacrifice of life which this spirit of humanity entails urjon our profession ? Shall I speak of it * Rev. Joseph Eldridge. 11 here, while the names of so many young men who have been sacri- ficed at their posts in the various hospitals of this city, are still fresh in the memories of so many present ? Long is the list and how rapidly increasing, of those young phy- sicians and more advanced practitioners who have fallen victims to typhus. The very ships which transfer the starving thousands of Europe to an asylum on our shores, also bring with them, and produced by them, the pestilence which has removed so many from our profession. Yet the community entirely ignores all this sacrifice of life; while the complaint that the importation Of so much poverty leads to increased taxation, is often repeated. Indeed no small part of the loss of life alluded to is indirectly attributable to the parsimonious management of non-medical boards, resulting in imperfect ventilation, or perhaps compelling too great an amount of labor by attending physicians. since the required number of assistants would increase the expense of the establishment. I honor that benevolence which has established the hospitals for emigrants, and for other purposes, in this and other cities of our country. I would record my admiration of that munifi- cence, without a parallel in city governments, which has erected the establishments at Staten Island, and at Ward's, and Randall's Island-. But as a medical man I would also record the fact, that while every thing possible has been done for the emigrant, the physician on whom alone all the danger falls, has sometimes been unreasonably and even wantonly exposed ; and more than all, that for all this risk and ac- tual loss of life for the benefit of the emigrant, medical men are not allowed even that slight return which alone is asked by them; the least that could be either asked or granted, though of immense va I in- to them ; reasonable in itself, and of no possible injury to any one— are not even allowed those means of anatomical study, which such establishments alone, to any considerable extent, aftbrd. And worse still—that this prohibition against the only means of acquiring a know- ledge of that department which lies at the very foundation of all me- dical skill, is made, not at the request of the emigrant, nor with his knowledge even; but all this is done merely for political effect.* * It is well known that during the last winter more than 600 young men in the medioal schools of this city, unequaled in this country in its resources in all the practical branches, had their anatomical studies arrested for weeks in succession from the causes alluded to. Recent arrangements will, however, prevent such a recurrence in this College. 12 But while other men of influence are securing this result, if a physi- cian, from a want of that kind of knowledge which he is thus pre- vented so far as may be from acquiring, fails to answer their expecta- tions in case of a fracture or a dislocation, they are very ready to institute a legal process against him. How far this state of things is intended by the city authorities, I am not informed; but for State legislatures to enact laws punishing a want of medical skill with severe penalties, and at the same time others closing up the avenues through which alone the very foundations of medical skill can be acquired, is surely an exercise of their functions more worthy of a period remote in the past, than of the age in which we are living. But ordinary practice, independent of hospitals, also entails a great sacrifice of life. According to the statistics of Massachusetts for 1846, the average age at death of clergymen is 64; of lawyers, r>9 ; and of physicians, only 47. Well may we with Tulpius adopt as our motto: "Aliis inserviendis consumor." Still further proof of the high moral character of medical men is found in the fact that every good cause finds a large proportion of its supporters, and often of its originators, in the medical profession. This fact, and the unostentatious manner in which this influence is usually exerted, is confirmed by a recent writer. " No sect, no party," says he, " has reckoned many of our profession among its clamorous advocates; but wherever there has been any association of good men for laudable ends—wherever any institution has sprung up having science or literature for its object—or any great scheme of benevolence been designed or perfected—medical men have always been found among their first, their most zealous, and their most useful supporters." The Temperance Reform may almost be said to have been orig- inated by a physician—Dr. J. Torrey, of Beverly, Mass. A Com- mittee having been raised at a clerical meeting in 1811, to report what could be done to arrest the alarming progress of intemperance, consisting of four clergymen, two lawyers, and two physicians, at its first meeting did nothing more than to decide to bring in their thoughts on paper, at an adjourned meeting. At this meeting, one of the clergymen presented an elaborate performance on the form- idable nature of the malady; and one of the lawyers recommended vigilant attention to the license laws. 13 Dr. Torrey simply presented the following remedial prescriptions: 1. "Let each reformer set a wholesome example of abstinence himself, so that the proverb, 'Physician, heal thyself!' cannot apply to him." 2. " Let hospitality be shown in better ways than in applying the bottle to our neighbor's mouth; endeavoring to render it as unfash- ionable to offer, as it has been to withhold it." 3. " Furnish to laborers no spirits, but a better substitute." 4. " Let associations be instituted on the above principles, and lectures, addresses, and discourses be encouraged to enlighten the public mind." This was the beginning of the Temperance Reform, and this plan of Dr. Torrey fully justifies the remark that medical men " from the outset understood what the exigencies of the case required, and so fully matured their views as to leave us nothing at this late day to invent for the reform, in addition to what they purposed or at- tempted." The influence in this respect of Drs. Warren, Musscv. and Drake, besides many others I ought also to mention, has been most efficient and salutary. As another good cause which has been, and is much promoted by medical men, I will also mention the plan for sending the Gospel to the Heathen—the Missionary Cause. I do not here advert to the fact that physicians, quite as much as any other class, directlv aid this object by their pecuniary contributions, but to the immense influence exerted by those who have gone among the heathen as phv- sicians. I need not here say how much Dr. Parker has accomplished towards the introduction of missionarv influence in China. Indeed it is so well known, that a physician has means of act ess to the hea- then which no one else has, that it has ever been the policy of the American Board to induce the clergymen they send abroad to attend somewhat to the study of medicine, in order that through their med- ical services they may obtain an opportunity the better to accom- plish the great object for which they are sent. For it is a delightful peculiarity of our art, that it may be applied to the relief of suffering. unrestrained by geographical limits or human customs, or diversities in languages even. Wherever in the world we find disease, whether in the savage or the man of highest cultivation—whether we under- stand a word of the language of the sufferer or not—there mav we perform the appropriate duties of our profession. And wherever a 14 fellow being is relieved by it, it extorts his confidence and his grati- tude. Can the same be said of any other profession? The univer- sality of our art is as peculiar as its utility and its humanity. Few, indeed, realize how much the progress of civilization through- out the world has been promoted by medical men. By the applica- tion of sanitary laws founded on data which medical science alone can furnish, they have prevented a vast amount of human suffering, and a vast sacrifice of human life ; having thus raised the probable duration of life in England from 20 years (as in 1700), to 45 years (as in 1847), or more than doubled it in 150 years. Jenner's disco- very alone reduced the number of deaths in London from small-pox, from 2,400 to about 325 per annum. Who can compare with this* physician as a benefactor of his race ? At the time of his discovery, this disease was in Great Britain destroying 40,000 annually. " To medical men are humanity and civilization indebted for staying the awful ravages of the plague and other communicable diseases, by i|uarantines; for the present salubrity of many districts; for the almost complete extinction of scurvy by land and sea, and the glory of hav- ing stricken the chains from the limbs of the maniac."* Peculiarly applicable to medical men as a class, is the Well-known line of the Latin poet: " Quique sui memores alios fecere merendo." The comparative moral character of the medical profession in France, may be inferred from the following statistics from the Moni- teur, a Parisian newspaper. In the years from 1829 to '39, it ap- peal's 41,679 male prisoners above the age of 25 years, were tried in all the criminal courts of France. Of these 75 were notaries; 0*5 were constables; 33 were priests; 33 lawyers ; but not a single me- dical man. Indeed but two physicians have been tried in France as criminals, from the year 1829 to 1847 ; so that it has been found impossible to fix a fractional ratio by which to compare physicians with other classes, in respect to the commission of crime. Did the time allow, I would adduce proofs of the generosity of medical men, in the bestowment of their money as well as their ser- vices. A few illustrations must, however, suffice. The world-renowned Radcliffe Library at Oxford, was founded by the munificence of the distinguished London physician of that name, and who bequeathed Dr. A. Stille. 15 £40,000 to the University of Oxford for that purpose. Dr. William Hunter bequeathed £8,000 to the University of Glasgow, and also his splendid anatomical museum. Dr. Mead is said to have earned £5,000 in visiting the patients of Dr. Friend, while the latter was confined in the tower for a political offense, and to have given it all back to him on his release. Mr. Dixon, a surgeon at Preston, recent- ly declined a legacy of £3,000, that it might be divided among the nephews and nieces of the donor. Lancisi, the Italian physician, founded a Library of 20,000 volumes for the use of the public. But I need not multiply similar instances, nor go to foreign countries for them. Within the last five years, Dr. C. Wilder, of Leominster, Mass., has given $20,000 to the Massachusetts General Hospital; and Dr. Wile}7, of Brooklyn, as is announced within the past month, has bequeathed $25,000 to various charitable institutions in that city. If I may trust my own observation, I may say. that no class of men are so munificent, in proportion to their means, as medical men. I shall show that the means of medical men as a class, are compara- tively limited ; and therefore they, like all other professional men indeed, cannot be compared with one other class, as to the aggregate amount of their charities. I allude to the merchant princes of our own and other countries; the most large-hearted and munificent, as well as the most enterprising, far-seeing and discriminating, of all classes of men ; and whom God seems to have made the special de- positories of wealth in order to advance, through their liberality, the cause of humanity, civilization, and religion throughout the world. Finallv, I will allude to the moral courage of medical men as a class. No one but a physician can accurately estimate the necessity of this trait in the practice of our profession, or discriminate the cir- cumstances in which it is the most called for, or in which it is actu- ally called forth. For it is not always manifested in what we do, but very often, in what we decide not to do, and which others perhaps are urging upon us. It is also manifested even in the faithful attendance upon any of the malignant and contagious diseases, by one who has never had the disease in question; and yet how little credit is given to physicians for this. Still, the amount of mortality in our profession from typhus and cholera alone, thus contracted, has been truly fearful; the actual risk of life to physicians thus employed, being much greater than that of soldiers engaged in battle, as I could adduce the statistics to 1G show. Far more courage was required to enable Dr. McWilliam to pertorm what he did in the expedition of the Niger, amid the horrors of the Boa Vista fever, than is necessary to face the enemy in a series of battles. The sacrifices of the physicians of Sandusky city, during the prevalence of cholera in 1850, are another marked and honorable ilhi-tration. And if we would also seek for that other kind of courage called braverv, it will also be found in all as a class who have the op- portunitv to manifest it. The journals contained numerous illustra- tions of it during the recent revolutions in France, and the Holstein war; 2 surgeons being killed and 18 wounded in the battle of Istedt in the army of the Dutchies alone. Military surgeons have ever been remarkable for their bravery. The lives of Larrey and of Guthrie abound in illustrations ; the latter having been twenty-two times ex- posed to the fire of the enemy during the war in Portugal, Spain, France, and the Netherlands. But this must suffice in the way of facts and testimony, in regard to the actual moral characteristics of the medical profession. I may, however, be expected to give a passing notice to certain scandah against it, which are often repeated, and which, were they true, might invalidate the views I have advanced. It is often asserted that envy and jealousy are very prominent traits in medical men, especially in their professional intercourse; a peculiar tendency to infidelity has also been frequently imputed to them; and sometimes, also, an avaricious spirit, or a proneness to make exorbitant charges for services rendered. I. I have, by no means, intended to convey the idea that medical men are exempt from the frailties incident to human nature. We see jealousies between those whose interests come into competition, in every profession, not excepting the clerical even. If this weakness is more frequently manifested in medical men, it is because medical men, more than all others, are exposed to the circumstances which call it into exercise. The clergyman has his duties clearly defined, and his in- come definitely settled, before he enters upon them ; and if another comes into his immediate neighborhood, that fact alone is a warrant that A. also has his limits of official duty assigned him, and his salarv secured. There can, therefore, be no possible competition between them, and no possible reason for jealousy, in any ordinary circum- stances. How different the physician in this respect. One alone per- haps ^ competent to do all the business 0f a town or village ; and 17 this amount of business is barely sufficient to give himself and fa- mily a comfortable support. In these circumstances, is it in human na- ture not to look upon another who comes to compete with him for this business, with some degree of jealousy ? Again, a physician's success. depends so directly upon his personal reputation, upon what is said of him from day to day by those around him, that the least unfavorable remark from a professional brother may do vast injury. This will na- turally make physicians sensitive to each other's remarks, and hence may sometimes lead to misconstructions and misunderstandings where there has been no sinister motive. Free expression of opinion among clergymen would naturally be more likely to be overlooked, because it is not supposablc, in most cases, that the speaker had any selfish end in view. But when it becomes apparent to a clergyman that another is traducing him for his own aggrandizement, I am not aware that less feeling is exhibited than by a medical man in similar cir- cumstances. I have seen a medical man, under the circumstances supposed, manifest a forbearance and a nobleness of character, which, were it a solitarv instance of the kind, might well entitle him to a place in the calendar. And if legal men are less jealous of each other than physicians, the reason is at once apparent. Every one knows that in every case of litigation in which one lawyer is employed, another at least is sure to be, and oftentimes half a dozen together; while it is only in excep- tional and the most difficult cases, that even tiro physicians are required at a time. II. In regard to the greater proneness in medical men to infidelity. I will merely sav that this falsehood originated in the 13th century, from the malice of the priesthood, on having the practice again wrested from them by regularly educated physicians—they having assumed it and taken all the fees, for a century or more before. Their only method of revenge for their lost perquisites, was to utter the charge of infidelity, in order, if possible, to frighten the people generally back to the monasteries for medical aid. " Ubi tiesmedici, duo sunt Athei," was the charge; and that has now been repeated from time to time for nearly seven hundred years—it still remaining however, as it was at first, a libel and a lie. I do not deny that some physicians have been, and that some are, atheistical. But if so, there are as many in every other profession, the clerical alone excepted. But an infidel lawyer'escapes detection, or his employer cares not if 2 18 he be actually such, and never alludes to the fact; while a physician's moral and religious principles arc narrowly scanned, fully ascer- tained, and made not only a subject of remark, but also a matter of feeling, with his patients. And this is as it should be; and let him who cannot stand the ordeal, withdraw to some other vocation. It would not be difficult to show, I think, that medical men, as a cla>s, are tar more religiously inclined than other men, excepting clergymen, instead of being less so. "I assume for clergymen," says Rev. Dr. Putnam, before quoted, "no supeiioritv in virtue or the sentiments and sympathies of humanitv, over physicians—the physician enters the chamber of sick- ness and the scenes of pain, death, and sorrow, with as soft a tread, as gentle a voice, and with as warm a current of affection in his heart as the clergyman." Many might be named who, like Sydenham, Boerhaave, Ambrose Bare, Hey of Leeds, Hope, and Brodie, and many others still living, and in our own country, adorn their profession even more if possible, by their christian character, than by their splendid intellectual and practical acquirements. Still, I am free to allow that, from supersti- tion and fanaticism, medical men, as a class, have ever kept aloof, and the peculiar character of their studies accounts for this fact. Espe- cially applicable to the physician in this respect, is the well-known passage from Virgil— "Felix qui potuit rerum cognoscere causas, Alque metus omnes, et iuexorabile fatum, Subjecit pedibus, strepitumque Acherontis avari.'' And I should not, in justice to my profession, fail here to speak of the vast influence in favor of morality and religion, which has been exerted by medical men. The whole science of moral as well as of intellectual philosophy has been essentially constmcted by the labors of medical men. John Locke, Hartley, Mackintosh, and Brown, were all medical men ; and the writings of Bonnet, Abercrombie, Fothergill, Jones, Lettsom, and Rush, of our own country, have exerted a powerful religious in- fluence. Indeed, I ought also to add that even the Reformation in Ger- many from Rationalism* second in importance only to that accom- * An English clergyman—a Dr. Farmer—first instigated this phase of skepli- cism by his work on Demoniacs. 19 plished by Martin Luther, was mainly achieved by the writings of a German physician—Dr. Heinroth, of Leipsic. III. In regard to exorbitant charges, I will affirm of the vast majority of my profession, that no class of men are so poorlv compen- sated as physicians. No men give away so much of their time for absolutely nothing, we have seen-no men make so low charges in proportion to the benefits conferred ; and by some persons also, none are so grudgingly paid, unless paid while the value of their services is fresh in recollection. Indeed there are some people to whom, as old Ericus Cordus remarks,— "Three faces has the Doctor—first, when sought, An angel's ; then a God's—the cure half wrought— I5ut when, that cure complete, he seeks his fee, The Devil himself, looks then no worse than he." It would be scandalous to say that more than a very few of our patients are of this class; on the contrary, the grateful acknowledg- ment of our services by our patients, as a general thing, is the great charm of the physician's life; and without which, that life of anxious toil would be miserable indeed. But the fact that the other kind of a patient is now and then met with, and sometimes when least ex- pected, has caused physicians generally to be tardy in presenting their bills, and thus to lose a large portion of their hard-earned wages. Still the physician is expected promptly to pay all his own bills, to maintain a more expensive establishment than the clergy- man or the lawyer of the same relative rank, and also to contribute his pecuniary means to all the charitable objects of the day, and to the salary of his pastor also; in addition to his gratuitous professional attendance before alluded to. The result of all this is, that very few medical men comparatively, acquire even a competence by their professional labors; and to ac- quire a large property is almost out of the question. Dr. Johnson, in his disgust at Swift for his unprovoked bitterness against medical men, and accusations of exorbitant charges, used to defy him to men tion a single instance in which a physician in England had amassed a fortune from his profession. How many instances can be mention- ed in which a large property has been acquired by the regular prac- tice of medicine in this city \ Not one, probably, to 30 acquired by the practice of law—not one to 500 acquired by trade. I admit that some mean and avaricious men are in our profession as well as in 20 e\ery other. But his observation must have been very limited who does rfot know that generosity and liberality are among the most prominent traits of medical men as a class; though every illiberal act of theirs is judged more severely than the same in other men. And I should also have alluded to the fact, that medical men have comparative injustice done them in many other respects, by being judged by the community at large by a higher standard than is applied to other men. In regard to the virtue of patience, they seem to be expected to rise to the standard attained by Job, at least. The physician must hear to its finale, the interminable catalogue of aches and ills of the valetudinarian—who is ever, like the spider, spin- ning a thread out of his own bowels—without the least expression of impatience, or he is thought by the speaker to be a very unfeeling man. He must also passively submit to the peevishness and irrita- bility, and unreasonable faultfinding of nervous disease, and to the obstinacy of children; and listen passively to the garrulity of age and e\ en the gibberish of imbecility. In a hundred other circum- stances also, of trial to the feelings, he is expected to restrain all ex- pression of feeling; while any other man would be thought to be wanting in spirit, and would actually be blamed by the commu- nity, if he did not strenuously reluctate. The surgeon also, who knows that the least deviation of his knife, the least tremor on his part, in a hazardous operation, may compro- mise the life of his patient, and yet by an intense effort controls his feelings, and maintains the coolness necessary to enable him to sav*1 his fellow creature's life, and thus dexterously accomplishes his fearful and responsible task, is spoken of as a very reckless and cruel man ; and perhaps it is remarked .that he even seemed to enjoy the exercise. " Why," says one, " he cut off the limb as coolly as a butcher would detach a round of beef." " () yes," replied another, " you know the praetice of medicine makes a man hard-hearted." But could you feel as that man felt for his patient before he began the operation, and as he feels after it, and realize the effort necessary to keep his feelings in abeyance during it, that ho may perform it in the best )^siUe manner, you would never repeat an assertion so outrageously false; but would, instead, thank God that he has given to some men of tli,, kindest hearts the power to do things so revolting to their feel- ings, for the good of their fellow men. I admit that some very little great men have given some color, by their manner, to the above in- 21 sinuations; seeming to think it very manly, or something more than manly, to evince in such circumstances a total want of all human sympathy. But the whole man, the man who ever had a heart in his bosom—and no man without a heart can ever be great—is never seen to do this. And such a man, the more he finds it his duty to perform those unpleasant services to which I have alluded, will find his sympathies more enlivened, and his feelings more refined and elevated. Indeed, there is no class of men in whom we at all times see " prompter effusions of benevolence," than in the best surgeons— the truly great surgeons in this and in other countries ; and the very personification of philanthropy and benevolence, the world-renowned Howard, we may remember, was also a medical man. Thus it appears that the practice of medicine more than any other profession, demands the incessant influence of high moral prin- ciple ; that it more than any other tries the feelings, and tests the moral character, but at the same time exalts both; that the medical profession has ever possessed as high a character for virtue and mo- rality as any other, and as high a religious character also, the clerical profession alone excepted; that in the practice of medicine all baser metal, all counterfeits, will surely at length be detected, while the pure gold of moral excellence will also be discovered and justly ap- preciated ; that medical men are judged by a higher standard of moral character than is applied to other men, but it is certainly our own fault if we do not elevate ourselves to its requirements. A good moral character is indispensable, therefore, in a medical man; and is the indispensable basis upon which the intellectual part of a medical education should be erected. How, then, can private medical teachers, and the medical schools, elude tl»e duty of preventing, so far as may be, the admission into the profession of immoral men ? No physician should receive into his office as a pupil, a young man whose moral character is objectionable, and private teachers generally have opportunities for certain knowledge in regard to this matter; but should, on the contraiy, dissuade all such from studying medicine at all. No preceptor, who is himself a good man, is ever honored in the end by an immoral pupil, however intellectual he may be. Yet 22 by tar the greatest amount of the immorality actually existing in our profession,'is traceable to a neglect of duty in this respect. But the dutv of the schools is not less binding, nor less important. The great object of their institution is the advancement and elevation of the medical profession in all respects; and they are either entirely ignorant or utterly unscrupulous, who would pervert them to their own personal advantage. From the fact also that the schools de- pend on the profession for their support, they are bound not to thrust into it such as either from bad moral character or deficient in- tellectual qualifications, will disgrace it, and thus bring personal dis- honor, in some degree, upon those who have already become.honor- ably connected with it. Indeed, the schools have recognized the duty 1 am inculcating, by requiring certificates of good moral character as a pre-requisite to graduation. But it is well known that every man may obtain such a certificate from some source, and, there fore, any school is liable to imposition in spite of all possible precautions. But does the blame justly fall upon the schools in such instances ? ('er- tainly not—but upon the previous teachers of such young men, who had cverv opportunity to know their true character, and yet sent them to the schools, and, perhaps, as generally happens, almost as a matter of course, also gave them the necessary credentials. It is cer- tainly too much to require medical schools, besides storing the intellects of their pupils, to convert immoral into moral young men. But since the evil of sending such men to the schools exists, without any check in the power of the latter, it is their duty to impose still other criteria of character, so far as is practicable, in order to guard the profession in every possible way in this respect. And this also the profession has the right to demand. And just so far as a school gives its diploma to irregular practitioners of any kind, it is directly contributing to disgrace the regular profession; and by such acts for- feits all claim to the patronage of the same. So far, also, that school commits an immorality, for which it should be held responsible to the last degree, if committed with a full knowledge of all the facts at the time. I well know the difficulty—even the impossibility—of ascertaining the truth in all cases, for the reasons before mentioned. But the graduation of irregular practitioners may be guarded against, in a great measure, if not in every instance, by requiring every candi- date for a degree, to sign a pledge-, to be preserved hereafter, to the effect that he will never engage in any irregular s\ stem of practice; 23 will maintain an honorable intercourse with his professional brethren ; and will endeavor to promote the interests of his profession in every' honorable way. What glory can accrue to any school from the graduation of such men as would refuse to sign such a pledge ? And what public teacher can wish to graduate such men on any account, unless he considers his responsibility to his own pocket paramount to his duties to his profession ? This college, gentlemen, has the honor of first requiring such a pledge. Already, its example has been fol- lowed by another school ;* and, ere long, we hope to see it imitated by every respectable medical institution in the country. I have said it is too much to require the medical schools to make moral physicians out of immoral and corrupt students. But I add, that it is not, however, too much to demand of them that they shall not encourage students in their immoralities—that they should not connive at the falsehood of those who pretend to be preparing them- selves for the practice of medicine, till they get their diploma, and then throw oft" their disguise and engage in irregular practice. It is also not too much to demand of the schools, that they shall not set an example of falsehood themselves to their pupils, by professing to the public that none can obtain a diploma without a three vcars' course of study, and then confer their degrees after a course of a year or two, just to suit applicants. But a low estimate can that public medical teacher have of his duties to his profession at large, and but a slight degree of self-respect, who will not in every way manifest his entire dis- gust at all such practices. And we who attempt to teach, are bound at least not to make our pupils worse, if we do not make them better; we are bound to manifest, on all occasions, by our example and by precept also, so far as may be proper, our recognition of the highest and purest moral principle, as the main and indispensable element in the medical character. What, then, shall be said of such teachers, as in their public lectures and private acts pander to the lowest appetites of those who look to them for instruction'? So long as such are found in professorial chairs, the scandals against our profession, to which I have alluded, will continue to be repeated: for so long there will still be enough immoral men in it, to attach some degree of disgrace to the whole. It is for the profession to single out such teachers and such schools, and bestow its patronage accordingly. * The St. Louis University. 24 But finally, medicals student also have a duty to perform in this rcsjiect.- It is true, they have no opportunity to learn it, perhaps, till thev have selected their preceptor, and possibly it never occurs to them till they have even received their diploma. But it is their duty, and at the same time their interest, so far as they may, to patronize only preceptors and schools of the best character, in a moral point of view. For every medical school has a moral character and an intel- lectual, as well as its individual professors; and, were I to send a son to a medical school, I should take especial pains accurately to settle the question of character, present and prospective, before I decided what teacher or school he should patronize. Having decided what teachers and what school to patronize, you will not fail, young gentlemen, to recognize it as the duty of each to fulfill, so far as in him lies, the high hopes of those so near and dear to him, from whom he is for a season to be separated ; still remaining uncontaminated by the temptations of a great city. For however great the intellectual progress you may make, unless you preserve un- spotted your moral escutcheon, you are unfit for the noble employ- ment to which you aspire. In it, above all, it is true that "the evil bow before the good ;" and in every vocation, -----*' Talents angel bright, If wanting worth, are shining instruments la false ambition's hand, to finish faults Illustrious, and give infumy renown." I