INTRODUCTORY LECTURE BEFORE THE IMEDICAL CLASS! (9 (?"K UNIVERSITY OF LOUISVILLE, DELIVERED NOV. J. \(). 1 \ IMTRODUCTORY LECTURE ^ y BEFORE THE MEDICAL CLASS UNIVERSITY OF LOUISVILLE, DELIVERED NOV. 4, 1850. 1/ BY LEWIS ROGERS, M.D, PROFESSOR OF MATERIA MEDICA ANO THERAPEUTICS. LOUISVILLE : MORTON & GR1SWOLD, PRINTERS is-:o. CORRESPONDENCE. Louisville, Nov. 6, 1850. To Professor Lewis Rogers : Dear Sir.—On behalf of the Medical Class of the University of Louisville, we their Committee tender you our warmest thanks for the very excellent and- appropriate address delivered before them, on the evening of the 4th inst. We earnestly desire that you will gratify the unanimous wish of the Class, by furnishing a copy of the same for publication. With sentiments of the highest esteem, We remain yours, &c. ADAM GUTHRIE, of Ky. WILLIAM E. ROBINSON, la. JNO. S. DUVAL, Tenn. LEONIDAS B. BROWN, Mo. ABRAM K. KELLER, 111. JNO K. THOMPSON, Miss. WILLIAM R. JOHNSTON, Ala. R J. GILLILAND, S. C. AL*BERT DUNLAP, Ark. THOMAS B. HARRISON, Ohio. SANFORD REAMEY, N. C W. W. CARTER, La. H. K. LINK, Texas. W. R. HOLMES, Ga. Louisville, Nov. 7,1850. Gentlemen,—In compliance with your request, I herewith transmit a copy of m\ Introductory Address. I beg vou to receive for yourselves, and express to the Class, my most grateful acknowledgement of their too flattering appreciation of my humble effort. I am, very sincerely, your friend, LEWIS ROGERS. To Messrs. Adam Guthrie, Will. E. Robinson, John S. Duval, &c. Published by order of the Class. W. Boyd, Secretary. R. A. NEW, CI airman. LECTURE, Gentlemen of the Medical Class : As the organ of the Medical Faculty of the University of Louisville, it becomes my duty, as it is my pleasure, to welcome you to a participation in its benefits, and its honors ; to initiate you in those important and interesting relations which are to subsist between us as preceptors and pupils, and members of the same great profession. The occasion which calls us together is one, which, periodical as is its recurrence, is always of more than ordinary interest. We meet together this evening, not merely for the gratification of an enlightened curiosity, or the satisfaction to be derived from listening to a lecture necessarily imperfect and evanescent in its character ; but for the more important object of entering upon the per- formance of duties and labors which are to engross our thoughts now, and furnish the aids and appliances by which we are to achieve fame and fortune hereafter. To the student the occasion is fraught with peculiar interest. He has severed, for a season, the ties which bind him to his home; he has relinquished the manifold delights which cluster around the domestic hearth; and perhaps at great personal and even pecuniary inconvenience, has come hither, a stranger among us, to avail himself of the more thorough professional ministrations only to be found in alarge city, and in a long established school, and to perfect him self in every thing that pertains to the science which is to enable him to alleviate the sufferings incident to humanity, and conquer for himself independence and distinction. To the teacher too, it is an occasion replete with the gravest considerations and the most absorbing concern, if he feel as he should the responsibilities of his position. And he must be recreant indeed to the high trust confided to him, and to every ennobling emotion and generous sentiment, which the 6 nature of his pursuits is so eminently calculated to inspire, if he can contemplate these responsibilities, without being oppressed with a sense of their momentous importance— without indeed, many and painful misgivings of the efficiency of his own exertions, however honest or however zealous. The position of teacher in any respectable institution of learning,|medical or otherwise, presupposes in the incumbent, talents and attainments equal to the requirements of the station; talents and attainments which have gained for him a name and reputation, which should stimulate him, not merely to preserve what he has secured, but to increased effort for wider usefulness and loftier distinction. The commencement therefore, of a new course of lectures, lo a man who appreciates properly the magnitude of his responsibilities, and the preciousness of his own character, is necessarily a period of profound solicitude. Before him he sees assembled a multitude of faces, some of which are familiar, but very many, if not most of them, strange and hitherto unknown. He imagines, nor are his imaginings altogether astray, that the intent and eager crowd which is gazing upon him, is prepared to scrutinize every look and gesture : to weigh every word and sentence with critical severity; to pardon no offence against good taste ; to forgive no errors of fact, no heresies of opinion. He feels that it is their privilege to do this, and yet if he be true to himself and his calling, he will rather invite than shun the closest and most searching examination ; for he knows, or ought to know, that only in this way can error be detected and the truth be made manifest. But while he does not deprecate criticism, he has a right to expect that he will be judged with kindness and with candor, that if nothing be extenuated, nothing at least will be set down in malice. On an occasion like the present, it is not expected, nor, indeed, would it be proper, to select a theme strictly limited to a professional audience. Before a mixed assembly, it is the dictate of propriety as well as of good taste, to choose some topic, which, while it is professional in its design, will admit of being popularly treated and excite extra-professional interest. The catalogue of such topics is diversified and extensive enough to render the choice both difficult and perplexing. The profession of medicine is usually selected and prosecuted under the influence of motives and consider- 7 ations very similar to those which actuate men in the business affairs of life generally. The most influential of these motives and considerations, are the acquisition of the means of living, and beyond this, the accumulation of wealth ; a philanthropic desire to be useful to our fellow men, and an ambition to occupy a distinguished place in the esteem of the country and of the world at large. Very few young men commence the study of medicine with no higher purpose than the mere sordid pursuit of gain ; the aspirations of the young and ardent mind, are usually of a more pure, generous and elevated order. By far the larger part, however, look to such acquisition as one, and not the least important of the ends to be attained, and no desire can certainly be more legitimate and praiseworthy, when restrained within proper bounds, and pursued by honorable means. All men hope, and most men strive, for independence. The first object of every rational being is the supply of his own natural and necessary wants ; for no man can work with earnestness and effect, whose mind is constantly on the alert, to secure a lodging and a meal. It is only when these are placed beyond chance, or change, that his energies can have full and free scope, and his intellectual attainments a fair field for their unfettered exercise and worthy display. But while such pecuniary success as will place the physician beyondthe exigencies of poverty, ought to be aimed at and desired by all, the practice of medicine as a mere trade is unworthy and disreputable, and incompatible with the lofty character of a liberal profession. The man w.ho embarks in the profession of medicine with an exclusive regard to the pecuniary rewards which may be reaped from it, will not and cannot penetrate the profound depths of the science. It is true, that if he consult his permanent success, if he aim to place his selfish plans upon a secure and substantial basis, if his purpose be to prosecute his schemes of mercenary aggrandizement, through a series of years, or for a life-time, common sense will dictate to him the expediency of strengthening himself with the resources of learning; but, he who is prompted only by the unvyorthy incentives to which I have alluded, will much prefer the easier methods of imposture and deception, to the more laborious and costly ones necessary to the full attainment of medical knowledge. 8 If the student be placed in a position to make the pursuit of gain unimportant, or surrounded by circumstances which induce him to look to the practice of his profession, merely or mainly, as a philanthropist, he will have the most elevatino- of all motives, to stimulate his exertions to the attainment of qualifications adequate to fulfil the require- ments of his exalted purpose. Benevolence, to confer the greatest good on the recipient, must be enlightened ; or however excellent the motive, what was meant as a benefit, mav prove to be a curse. The same philanthropy therefore which dictates the noble purpose, should urge the prosecu- tion of all the studies and labors, essential to its perfection. When ambition bids the student fix his gaze upon the eminence " where fame's proud temple shines afar," the same passion will urge him to summon to his aid, all the means which art, literature and science proffer, for the attainment of his honorable aspirations. In every part of the civilized world, and very especially in a country, the society and government of which are organized as ours is ; where freedom of thought, and freedom of action, are the prominent, and boasted traits in the character of the people, it matters not what may be the motive which rules the life of the professional man, whether it be the acquisition of wealth, the desire of usefulness, or the love of fame; popular favor is essential to his success. Without such favor, no man can reap the honors or rewards, which are the objects of his ambition. What it behoves the physician to do, to deserve success, is sufficiently apparent. Let him be accomplished in the qualities of the refined and urbane gentleman, and thor- oughly skilled by precept and experience, in the principles of the science, and the application of these principles to the prevention, palliation and cure of disease. With such qualifications, the physician is certainly deserving of public confidence, and as a general rule, will, sooner or later, succeed in securing it. But this is not always, nor invaria- bly the fact. ^ It often happens indeed, that such a man is outstripped in the race to preferment by the sciolist and pretender, or only succeeds after a long and disheartening contest, in attaining the position to which he is so justly entitled. It often occurs, that men of inferior talents, and very slender abilities, destitute alike of academical and professional education, but possessed of boldness of manner 9 and artful assurance, advance with rapidity to public favor, whilst modest merit, talents of a superior order, extensive and accurate knowledge, are passed by unnoticed, and suffered to languish in obscurity, neglected and unknown. There is no class of professional men, whose merits are so erroneously estimated by the public, as are those of medical men; none that encounters such a current of popular ignorance and prejudice ; none that has awarded to it so little of steadfast popular favor and affection, where so much of both is really deserved. For this, there must be a reason. I propose to discuss in the present address, the popular tests of medical ability, what they are, and what they should be ; to develope, to some extent, the cause s of the inaccurate judgment alluded to; to point out some of the reasons which have operated and are still operating, to produce the false and mistaken estimates so prevalent in the public mind; and to suggest some tangible and practi- cable methods, by which erroneous opinions may be prevented and corrected, and an award rendered more in consonance with real worth. Dr. Beddoes, a very distinguished English physician, once humorously remarked, that, " there are three things which almost every person gives himself credit for under- standing, whether he has taken any pains to make himself master of them or not. These are: 1st. The art of mending a dull fire: 2. Politics: 3. Physic." I shall not pretend to question, on the present occasion, the competency of the public in reference to the two former of these topics ; but I not only question, but wholly deny to the unprofessional mind, the ability to form sound and accurate opinions, in regard to the theory and principles of medicine. This must be obvious to the most casual inquirer, and perfectly apparent after even a superficial investigation of the character of the subjects upon which a judgment is to be formed. Medical theories, or the principles of medicine, are not simple and uncomplicated truths, a knowledge of which may be reached by an intuitive sagacity, naturally resident in every mind; they do not belong to the class of axiomatic propositions, the truth or falsity of which, is apparent on their first enunciation, requiring no process of intricate thought for their solution, but compelling conviction at the 10 instant of their suggestion. Such is very far from being the fact. Medical principles, are the slow product of patient thought, and well-digested observation, based upon an intimate acquaintance with anatomy, physiology and pathology, as preparatory to correct and philosophical deductions, from the healthy and morbid phenomena observed. The structure and mechanism of the human body, the normal functions of this structure, the multiplied deviations from states of health, and the intricate modes of these deviations, the influence of the various moral and physical agents of nature upon the human organism, these constitute the elements from which the principles of medicine are evolved. How is it possible for the unprofessional mind to grasp, or comprehend subjects of such intricacy, variety and magnitude, or to form a correct estimate of the manner in which they are comprehended by those who are invested with the title of physician ? Surely, the impossi- bility of the attempt must be obvious to every one; and yet nothing is more common than to hear people in all classes of society, expressing confident convictions of the correctness of a particular system of medical principles, and to find them ranging themselves with obstinate firmness, and more than common zeal, under the banner of this, or that system of practice. .The popular test of medical ability, founded upon an inquiry into the principles which guide the practice of the physician, must, for these and other reasons, therefore, be considered fallacious, and in the very nature of things, impracticable. Another test very popular, and one indeed, far more generally resorted to, than all others, is that which is derived from an observation of the results of different modes of practice, and of the treatment of disease, pursued by differ- ent practitioners ; a test founded apparently on the rule of "judging of the tree by its fruit." If popular observation were unerring, if it were not liable to be obscured, misdirected and vitiated by a thousand delusive circumstances, the test itself would likewise be unerring, and nothing more would be required to guide the generaljudgment, and to award to talents, learning, excel- lence of character and true skill, their legitimate position in public esteem. A brief consideration of this mode of testing the merits 11 of medical men, will serve to elucidate its true value and importance. The topic may be rendered more plain, by a few very familiar and intelligible illustrations. Two physicians have undertheir respective management, a certain number of cases of disease, of a similar kind ; it matters not what the special form of affection may be. In the hands of each, an equal number of the patients recover. Common observation would at once decide/that equal skill had been displayed by the two physicians. Let the treat- ment of the cases however be closely analysed, and the result will probably not be so fortunate for one of the parties. It will be found upon careful investigation, that the patients of the one physician have speedily recovered, have been subjected to very little active and disgusting medication, have a prompt convalescence, and return to their avocations, with their physical vigor not materially impaired; the art has been wisely and beneficently exercised upon them ; they have been healed, quickly, safely, and pleasantly. The others, on the contrary, have been subjected to a long course of disagreeable drugging, have a lingering convalescence, and though apparently cured, in reality return to their duties with crippled energies, and possibly with the seeds of organic disease, which in time will ripen into incurable distempers. This is no fancy-sketch, it is a matter of constant, and almost daily occurrence ; and yet the popular voice, will award equal merit to the two practitioners, or what is more probable, will give the verdict of superior skill to him whose cases were the most protracted, because, they were errone- ously supposed to possess greater original and intrinsic difficulty. The marked, and often vital, difference in the mode and perfection of the cure in the two instances, is obvious to the professional observer, but cannot be so to the unprofessional one. Another mode in which public observation is deceived, in regard to good and bad practice, is this. One physician is endowed by nature with a firm and hopeful spirit, and is ever disposed to look upon the bright side of every object presented to his' view; severe forms of disease lose much of their malignity, when contemplated through the medium of a cheerful disposition. Another physician of a desponding and gloomy turn of mind, will see nothing but danger and 12 fatality in precisely the same forms of disease. The public, unable to appreciate with correctness and impartiality the real amount of difficulty and danger, listening alone to the representations of the two physicians, tinctured as these are by their respective casts of thought, will be certain to award great skill to the latter, and very little to the former. Or it may be, that the one physician, honest and true, represents his cases in their real character, invests them with no false, nor factitious consequence ; whilst the other, for sinister purposes, magnifies every symptom, sounds the alarm when no danger is at hand, and conjures up men of straw, that he may gain the credit of vanquishing them. With chagrin and mortification, it must be admitted that this base and heartless device is often practised, and is often successful in achieving the purpose at which it aims. Again, mild forms of disease, when subjected to timely and skilful treatment are often subdued at once, and no further notice is taken of them ; the practitioner makes no reputation by the facility with which he vanquishes them; no eclat is gained for this easy display of successful art. The same cases, under a bad system of management, are often aggravated and forced into conditions of real danger ; and yet such cases, owing to the fact that bad symptoms induced by mal-practice are usually not fraught with such unhappy results as when they spring from the overpowering force of disease, usually recover, and are esteemed signal instances of the triumph of the healing art. The non-pro- fessional mind, unacquainted as it is with the natural tendencies of morbid action, and with the good and evil powers appertaining to medicines, cannot detect this great fault, and often metes out praise where a large measure of condemnation is due. The history of empiricism, furnishes a number of apt and instructive illustrations of the falsity of public opinion, as to good and bad practice. If public opinion co'uld be trusted, then long, long ago, had medicine reached perfec- tion, for when was there a time in which there did not exist, according to this " wise judge," some infallible panacea, some catholicon, some elixir of life, some form of remedies, or system of practice, competent to minister the means of prevention and cure, to all kinds of maladies. Each succeeding year, now, brings up some novel and startling form of medication, some newly vamped up system of 13 practical deception, which has its brief period of popular favor, and is then extinguished. Thus, one year, St. John Long's plan; another year, Morrison's or Brandeth's Pills, or old Dr. Jacob Townsend's Sarsaparilla; another, Homoeopathy; another, the water-cure, rules the fashion. J' So it has ever been. The same appeal has been made in behalf of all the delusions that Lave ever obtained currency in any community. The Indian who performs his strange and uncouth manoevres, and utters his howling incantations over his patient, and the Chilian doctor who blows vehemently about the bed of the sick, both, like the Thompsonian and Homoeopath, and the Hydropath, appeal to their facts, their cures, as the sure proof of the efficacy of their practice. The royal touch, the weapon ointment, the tar-water of Bishop Berkley, and the metallic tractors of Dr. Perkins, were each in their turn, the same way proved to the satisfaction of the great public, to be wonderfully successful in the cure of disease." It may be asked, is public experience to be wholly dis- carded, and the public estimate of skill in medicine, set down as naught ? My answer is, no. But then it can only be considered as worthy of confidence, when it is based upon the observation of many years, conducted by intelli- gence and discrimination, unswayed by prejudice or preconceived partiality, with an ample field, and a great variety of cases ; when limited in time, cursorily pursued, made up of the vague reports of incompetent men/and the exaggerated statements of interested parties, it is far more likely to lead to false, than to correct conclusions. Homoeopathy was tested in the French hospitals by a series of well-conducted observations, under the eye and guidance of Andral and other competent professional observers ; the object of the enquiry, was purely, the ascertainment of scientific truth ; no other motive could be suspected, and the result was widely different from that claimed for it, by the zealous advocates of this absurd and unnatural delusion. It is needless to pursue the argument more at length, to establish the position that unprofessional men cannot directly form accurate and reliable opinions, as to the correctness of the principles of medical practice, or of its actual results. They may however, and it is a duty which they owe to themselves, and to the claims of a dignified and learned profession, arrive indirectly at sound conclusions, 14 if they will incur the trouble of applying certain tests, which the unlearned may use as profitably and successfully as the learned. Medicine is ranked among the learned professions; and it is not arrogating too much to ourselves, when we assert, that its successful prosecution demands fully as much intelligence as the law, divinity, or any of the other pro- fessions. This learning consists not only of that which is purely professional, but of that which is derived from preliminary academical education. This preliminary educa- tion not only supplies a large and necessary amount of that kind of knowledge essential as the basis of all professional attainment, but when properly directed, imbues the mind with a taste for letters, refines the character, and establishes modes of thought and reasoning which pervade the whole future life. Whenever a physician asks the patronage of the public, that public should demand evidence of a certain amount of education. I know that education in our profession is, unhappily, ve^ lightly regarded by many people. Nor is this want of proper appreciation of its necessity, confined to the illiterate and the ignorant. The sentiment though seldom avowed, is yet to be found among the comparatively well- informed, who manifest it in their indifference to the true evidence of qualification, and the carelessness, nay, the culpable readiness, with which they place the veriest charlatan on an equality with, or even above, the thoroughly educated physician. Sometimes indeed, the opinion is freely avowed that a thorough education is not merely useless, but hurtful; that it cramps the powers, and warps by its facts and theories, that natural quickness of perception, and that shrewdness of observation, so necessary to success in the physician. Men, and in all other matters, sensible men, gravely affirm, that some persons are born doctors ; that they are naturally endowed with an intuitive apprehension of the nature and cure of disease, and point in proof of the correctness of their assertion, to the multitude of illiterate empirics who profess to have discovered remedies for every malady under heaven. They cite you with an air 01 triumph, to the numerous testimonials of miraculous cures effected by the thousand and one nostrums, which stare you in the face from the columns of every newspaper, and from the corners of every street; and tauntingly ask you if the 15 inventors or discoverers of these things were educated? They tell you that these evidences of success are worth more, and prove more, than any diploma from any college ; they insist that many of the most eminent men in other professions and pursuits of life, have attained their celebrity without the aid of early education, and why should it not be so in ours? That success is better evidence of skill than the mere possession of a diploma, is strictly true. But, unfortunately, the public is not possessed of the means of forming a correct estimate of the degree of this boasted success, or whether it exists at all. And as to the exceptional cases, of men who have achieved greatness in their pro- fessions, who lacked the aids of early education, they prove, if they prove any thing, the very reverse of the conclusion which is attempted to be drawn from them. They who rely upon these cases in support of their theory, overlook the important fact, that education, no matter where or when acquired, is education still; that self-taught men have, in spite of obstacles, which to ordinary minds would have been insurmountable, by dint of indomitable energy and uncommon intellectual power, secured for themselves the education at last, which circumstances denied to them at first. They forget too, that these very men are among the most earnest and eloquent in advocating, not the importance, but the necessity of thorough mental training, and have given utterance to the most touching lamentations over the hardships and mortifications to which they were subjected in its pursuit and acquisition ; and while these privations were sources of unceasing regret to them, they have been the most importunate with others, not to neglect the golden opportunities, of which they were deprived. Ail these facts are forgotten by the advocates of intuitive skill; facts which neither presumptuous ignorance, nor perverted knowledge can controvert or destroy. One of the safest guarantees that the public can have o the proper qualifications of a physician, is the possession by him of a diploma from a medical school of high standing and well-established renown ; a renown growing out of the character of its professors, its ample means of instruction its elevated standard of professional and academical attain ments, and the superior success of its numerous alumni Such an institution has a reputation to cherish, which wil 16 render it slow to confer its honors upon any but those who are worthy to wear them. # But a diploma is only a certificate of the attainments of the physician at the period of his graduation. The public should inquire somewhat into the habits of his life, subsequent to the acquirement of the doctorate. It too often happens that physicians bring to a close the pursuits of the student, when those of the practitioner begin. Medicine is eminently a progressive science ; year after year, almost day after day, it is speeding on in its course of wonderful advancement; the domains of all of its departments are constantly widening ; and he who folds his arms and pauses in the race, will find it difficult, if not impossible, to regain his position. The public has a just right to expect that every physician will keep pace with the progress of improvement, in order that he may be prepared to avail himself of all the known resources of his art. This important, but neglected test should be applied to every aspirant for public favour. The estimation in which a physician is held by his professional brethren, is another test of merit, upon which the public may very confidently rely. I know that there are difficulties in the way of obtaining a fair and impartial estimate of this kind. Professional rivalry interposes on the one hand, and may unjustly depreciate, while the partiality arising from common interests may, on the other, unduly extol. Medical, like other professional men, are not unfrequently divided into parties, and the spirit of depre- ciation and injustice, which is, if not a necessary, at all events, an unfailing element in the strifes and jealousies of party, is apt to warp and pervert the judgments formed by each of the other. But notwithstanding this, every physician forms an opinion as to the character and qualifications of those with whom he is in the habit of casual or constant professional intercourse ; and it will be found, that the aggregate opinion of the profession, in reference to any one member of it, will rarely very widely err. This purely professional reputation, the award of daily observation and association, and the knowledge necessary to arrive at correct conclusions by the application of te-fs familiar only to members of the samS profession, if du.y appreciated by the public, will very certainly lead to opinions of medical success and ability, almost always 17 accurate and just. If we desire to ascertain the character and professional standing of the person to whom we might fitly confide an important trust, to whom should we naturally apply for information as to his capacity, and the knowledge necessary to a proper discharge of the duty we would devolve upon him? Not certainly to those whose avocations are wholly alien from his own, but to those of kindred pursuits; to those who from habitual familiarity with the business to be done, and practical experience of the manner in which it should be done, would be the best prepared to counsel and advise. Why not then, in that most important of all earthly concerns, health, adopt and be governed bv the same rule ? There are certain tests, and these the most unerring, which only professional men can successfully apply to professional men; and if the public have any belief at all in the honesty and intelligence of physicians, it is but right that it defer to the judgments deliberately and impartially formed by them, of those whose modes of thought and action. from similar training, similar experiences, similar habits of observation, and similar application of the knowledge so acquired, in their daily pracuce, so closely resemble their own. But while people admit the correctness of such a test in all other occupations, do they admit it, or admitting, do they apply it in this, certainly as important as any other ? If they did, quackery and empiricism would not prosper as they do, nor make us so often blush for the credulity and weakness which rob true merit of its just rewards and appropriate honors, to confer them upon some illiterate and mischievous pretender. May we not hope that the march of improvement, which is every where active and onward, will correct this, the most pestilent and disgraceful of the many evils which so abound in this enlightened age ? But there are other tests, scarcely less accurate than those of which we have spoken, accessible to the unprofes- sional observer, and of ready applicability. To the character and offices of an accomplished and successful physician, certain moral and intellectual qualities *re indispensably necessary. When such qualities are known to exist, it may be safely predicted that the possesor is destined to be useful, and to attain eminence in his profession. if the gifts with which he is endowed, be rightly appropri- ated. But when the aspirant for medical honors is destitute of these qualities, or very partially endowed with them, it 18 is equally certain that no aids of education, no opportunities of experience can wholly make good the deficiency. The structure and functions of the body in health, the phenomena of disease, the causation, rise, progress and termination of these phenomena, their signs and symptoms, their diagnosis and prognosis, the physiological and thera- peutic action of remedial agents, these, and all other matters connected with the history and treatment of disease, demand the possession of certain refined and accurate powers of observation, without which the perception of such complex subjects, will be misty and obscure, and the language of nature erroneously interpreted. Observation of the phenomena of disease, and of the effects of remedies precisely as they are, constitutes the true foundation of all sound practical medicine. The fruits of this observation, compose the science of medicine. To collect, and properlv digest the truths and facts gathered by such observation, to weave them into harmonious forms, to educe from them guiding principles, require the possession of a mind strongly imbued with those great rules of inductive philosophy, to which Lord Bacon gave a new and lasting impulse. The bane of ancient medicine, was the predominant influence of closet-spun theories, unsustained by facts; the boast of modern medicine is, that these illegitimate usurpers, have been made to yield the sceptre to the guidance of a more sound philosophy. The possession of powers of observation, and powers of reasoning, such as I have thus generally portrayed, bestowed by nature, and cultivated into quickness, and activity by art, are indispensable, to the composition of th© accomplished physician. In these qualities, are embodied a great variety of subordinate traits, the necessity for which is universally recognized. In what way is the public to ascertain, whether the practitioner is possessed of these requisites ? What means can be used to find out the deficiency and its extent? We have seen, that the science of medicine is sufficienth- recondite to forbid the application of professional tests, by unprofessional observers. Such observers lack the peculiar information necessary to success in such an endeavor, and if they are rash enough to attempt it, they may " hazard a wide solution," but their conclusions are sure to be wrong. It they would avoid error, they must resort to means with 19 which they are themselves familiar; some standard derived from their daily experiences, and palpable, not merely to their own, but to the capacity of all. Let them, for example, observe the mental habits of the physician on any topic, with which they and he are alike conversant, and on the result of such observation, a very safe judgment may be formed. In this way, they cannot fail to ascertain the quality, and calibre of the physician's mind, and let the result of the examination be what it may, the inquirer may be assured that the subject selected will afford a fair criterion, by which to judge of his fitness to observe the facts, to apply the principles, and to perform the offices peculiar to his profession. The same habits of comparing facts, and opinions, and of educing conclusions, which are exhibited by him on common every day matters, are precisely those which will control his professional reasonings and conclusions. The circumstance that he is devoted to medical investigations, cannot and will not, materially modify his intellectual character, nor supply in that science, the tact and discrimi- nation* which are wanting on other subjects. The correct- ness of this position, must be apparent to every one upon the slightest reflection ; and yet it is one scarcely ever appreciated by the public, in its estimate of physicians. A distinction is often made between the man, and the physi- cian, and while to the one, are denied most of the attributes which jconstitute excellence of moral and intellectual character, to the other, are confided the tenderest and dearest interests of life. Let then the prevailing tendencies and characteristics of physicians in their ordinary intercourse with society, and on ordinary subjects be observed, and scrutinized, and an accurate judgment may be formed as to their capacity for reasoning and acting in matters purely professional. This test may be illustrated by a few familiar examples, which will at the same time disclose some of the qualities of mind necessary to success in the medical profession. Some men are very credulous; in conversation, the most improbable statements are received as truths, and in the common affairs of life, they are constantly betrayed into error by a too ready reliance upon every thing they hear. Can we question for a moment, that the same facility of faith will characterize the investigations, daily and hourly 20 forced upon them, in the discharge of their professional duties ? In a science, invested with so much uncertainty as ours necessarily is, excessive credulity must weaken, if it do not wholly vitiate, all the results of observation. If, on the other hand, scepticism be the prevailing charac- teristic of the physician's mind, the most powerful evidences of truth, will often fail to impress him, the rays of lio-ht which illuminate other minds will but serve yet more to obscure his perceptions, and doubt will unsettle, and hesita- tion paralyse his treatment of disease. Again, if a physician form his judgments upon ordinary matters hastily, jumping to conclusions before he has had time to examine the premises; overlooking all obstacles which lie in his way; no matter what degree of shrewdness and sagacity such a practitioner may exhibit, no matter how often he may be right, he cannot fail in the course of a busy career, to commit many and very serious blunders. To no such man, could we safely commit the management of any business of moment. Haste and precipitation are wholly opposed to correctness of judgment, and consistent action, on all subjects, but most of all, to the successful practice of medicine. Again, in the conflicts of opinion, we find a man painfully slow and cautious in forming his opinions, and immovably pertinacious in adhering to them, when they are formed. In the course of his investigations, no difficulty is overlooked; every pebble, becomes a rock, every molehill, a mountain; carefully and steadily, he encounters and removes every obstacle which obstructs his progress to his point of destina- tion. Now, this over-cautious and sluggish method of forming conclusions, though less objectionable than careless precipitation, cannot fail to be productive of serious disaster in cases demanding decision of action. The physicians respectively endowed with these peculiar- ities of disposition will carry to the sick-room, the character- istics which distinguish them elsewhere. The one, rashly and thoughtlessly wdl determine on a particular course of treatment, and discard it for another and another, should each, as is most probable, fail to answer his impatient desires. The other, will decide what is to be done after the most rmriute and tedious consideration, and when once Z mT \WlU admit °f no chanSe' wil1 n°t be convinced, *io matter what supervenes, that there can be anv possibility 21 of error in the course he has marked out. Live or die, there can be no mistake. There are others again, who entertain strong opinions on all subjects, and who express them with a supercilious dogmatism as insolently intolerant of any difference of sentiment, as of the feelings of those who presume to differ from them. It is singular enough, how often this assumption *of superiority is admitted by the public, and to what an extent, it secures for those who practice it, a recognition of superior acuteness and wisdom. Not perhaps, that any sensible man is really convinced that it is any thing more than one of the thousand artifices resorted to by men of overweening vanity, to acquire a reputation for the posses- sion of those very qualities, in which they are most signally deficient; but, as in the general intercourse of society, it is so much easier, as well as so much pleasanter to yield, than to combat, where nothing is to be gained by the encounter, where you cannot hope to convince, and do not care to be insulted; so too, in the practice of medicine, arrogant assumption comes to pass with the many for wisdom. Would an intelligent man of business confide the care and management of any affair, which required to be patiently heard and carefully examined, to an agent who professed to understand the whole matter before it was half stated ; and who, by some intuitive process of ratiocination, as yet unexplained, has mastered all the details of a difficult and complicated case, before he had heard one of them? Certainly not. Why then, in a matter of so much moment as the health of one's family and friends, should arrogance and assumption, receive the yielding submission which would be denied to them, in far less important concerns ? We can readily enough comprehend how such qualities should impose upon the ignorant, or the weak, but we are utterly unable to understand, how the intelligent, and the educated, can for one moment, be misled by an artifice so transparent, and so stale. True wisdom and true merit, are ever modest and unassuming ; nay, they too often shrink from, and shun the public gaze ; they scorn and cast from them, the meretricious arts and fantastic tricks, the resource and delight of charlatanry and empiricism. What then are the attributes, which should distinguish the true and genuine physician ? Not, as we have seen, the idle and ridiculous assumption of some inborn faculty which 22 enables its fancied possessor, to dispense with the recorded experience of long ages of observation and study. Not the rash temerity, which, while it does not absolutely reject the claims of investigation, leaps without pause or thought, to conclusions ; nor yet, the prolix and minute attention to unimportant details, which dwells with as much emphasis on a pin as a pyramid, and once resolved, is fixed forever. Not the credulity which believes every thing, nor the scepticism which hesitates and doubt about all things. Not, least of all, the dogmatism which arrogates universal knowledge, and is almost certain to be possessed of little or none. These are not the qualities, which should belong to the medical man. But a wise distrust of his own unaided powers, and a firm faith, in the benefits to be derived from the enlightened researches of the great and good, who have preceded, or are cotemporary with him, in the same honorable career. Boldness, controlled and regulated by care, in the examination of the causes which produce, and prudence in the application of the remedies, which are to soften or conquer disease. Patience, in studying the details which obstruct and complicate research, with sagacity to discriminate the important from the trifling, and ingenuous- ness and intelligence, to abandon a theory or a practise, whenever, or by whomsoever, proved to be unsound or unsafe. Scepticism, sufficient to stimulate inquiry into the novel opinions and alleged discoveries, which incessantly challenge the attention ; and credulity enough to receive as true, the statements of honest seekers after truth, until an extended and accurate experience, has established their falsity or their correctness. Positiveness, when the character of the physician, and the well-being and safety of the patient, require firmness of purpose, and inflexibility of resolve ; but always with a kind regard, for the feelings and opinions of others, and an urbanity and respectfulness of manner and expression, which no gentleman should ever, or under any circumstances, forget. I have thus summed up, as briefly and as clearly, as I could, the tests and the reasons for them, which professional as well as unprofessional men, may apply to the qualities, which should distinguish the practitioner of medicine ; tests, which will, if I have been at all successful in my endeavor, enable the community generally, to arrive at estimates very nearly, if not absolutely just; and to discriminate 23 .uerringly, and discriminating,to discountenance, the mani- fold forms of quackery and imposture, and to award to knowledge and desert, the honors and rewards to which they are entiled. And now, gentlemen of the medical class, permit me, in conclusion, to address myself directly, and especially to you. In the language of Milton, " I shall detain you now no longer in the demonstration of what we should not do, but straight conduct you to a hill-side, where I will point out the right path of a virtuous and noble education ; laborious indeed at the first ascent, but else so smooth, so green, so full of goodly prospects, and melodious sounds on every side, that the harp of Orpheus was not more charming." You have assembled here, to procure the study of a profes- sion, which is to be, not the amusement or the occupation, of a month or a year, but the business of a life, and the medium through which you are to fulfil the expectations of those who have watched over, and directed you hitherto, and realize the brilliant aspirations which have brightened the ever- shifting, but always beautiful and hopeful horizon, which circumscribes the enchanted vision of young and ardent minds. A thousand temptations, will beset your path. Some false Duessa, will meet you at every turn. Some Comus, will present to your thirsting lips, the drugged and potent chalice brimmed to the highest top-sparkle, with pleasures, whose taste is ruin. Some Circe charm, more successfully perhaps, than she whose enchanted music fell harmlessly upon the guarded ears of the wisest of the Greeks. Difficulty, after difficulty, will rise up, to thwart and discourage ; obstacles, overlooked or despised, in the outset of your career, will alarm the timid, and make even the most resolute pause. But let the temptations be resisted, the song of the syren, unheard or unheeded, the cup of pleasure dashed from your lips, and the first step, which is always the most difficult, in the path of duty, be taken, hkI the danger is past, the victory won. A resolute will, directed to lofty and ennobling ends, is equal to the accomplishment of all things this side of impossibility. And what more elevating object can tempt ambition, than the mastery of a profession, which con- tributes so largely to the happiness of erring humanity? What higher honors has the world to award than those which pain relieved, or sickness subdued, or health restored, 24 offer to him through whose beneficent and enlightened ministrations, these results have been brought about? In no other profession is the relation between the employer and employed, so intimate or so confidential; in none, are the interests involved, so directly and immediately important. In other professions, men confide their property to the management and direction of agents selected for their probity and skill in such matters ; to the medical man they commit that which is more precious than silver or gold or pearls of farthest Ind. Property lost or destroyed, may be recovered or replaced ; but health once ruined by ignorance or neglect, can never be restored or atoned for. How high, how sacred then, is the obligation which rests upon medical men, diligently, honestly and intelligently, to labor for the acquisition of the knowledge, without which, there can be no practical skill, no permanent success ! Distinction, and the rewards to which it leads, are to be won only by patient toil and protracted industry. Wishing and sighing imagining ;md dreaming of greatness, will not make you great. To achieve success, you must, work faithfully, zealously, with one object, and one only in view ; you must not permit yourselves to be turned aside from the legitimate and proper objects of your pursuit, by the fascination of those which are immaterial to its attainment, or alien from its purposes. It is true that by attempting the impossible, we often accom- plish the extremely difficult. But by attempting too much, by beating out our grain of gold to its utmost possible tenuity, do we not lose in solid strength, more than we gain by its glittering extent of surface ? The light of learning, should be the light of truth. It should illumine the darkness of error, and be the certain beacon to guide you through the hidden, the rough and the intricate paths of the profession you have chosen. The false lights, the counterfeited resemblances of the true and genuine, glitter around you in every direction, ;md dazzle you with their glare. But follow the one bright star which beckons you onward and upward, and your triumph is sure. And trust me, when your success is established, you will look back upon the toils, the privations, ;md the anxieties which attended your days of preparation, as the happiest of your life, and will feel, that the refl- ections of duty faithfully performed, are the last you would be willing to forego or forget. /r