' !^^^ //| VALEDICTORY ADDRESS, .-*♦ THE CLASS OF MEDICAL GRADUATES UNIVERSITY OF PENNSYLVANIA, THIRD OF APRIL, 1846. /\ BY —•"■* WILLIAM GIBSON, M.D., PROFESSOR OF SURGERY IN THE ONIVERSITV OF PENNSYLVANIA. a ;> ^h^: PUBLISHED BY REQUEST OF THE CLASS. PHILADELPHIA: L. R. BAILEY, PRINTER, 26 NORTH FIFTH ST. 18 4 6. VALEDICTORY. I have been accustomed to address you, my young friends, as students of medicine, as pvpils engaged in the slow and ardu- ous process of storing your minds with elementary truths, or of maturing your more advanced studies by the acquisition of accurate and comprehensive information in the numerous, diversified, and difficult branches of medical education. In discourses introductory to the regular lectures of each session, I have endeavoured to furnish you with such precepts on intellectual, moral, and professional subjects, as were best calculated, in my estimation, to lead to beneficial results. Need I say how well you have realized all my hopes, by your unremitting diligence and devotion to study, by your exemplary conduct, and by the quiet, unostentatious, and gentlemanlike manners by which these higher duties have been adorned. All my colleagues, I am very sure, will bear cheerful testimony to these truths, and will unite with me in proclaiming to your friends and to the world, how well you merit, the highest praises I could bestow. How, indeed, could it be otherwise; coming as you do from every part of our extended country, and here congregating as the sons and repre- sentatives of the most respectable and intelligent families of every state and city of the Union, accustomed from infancy to the best society, having received, for the most part, the finest educations, and entitled in every way, but chiefly by the aristo- cracy of intellect—the only legitimate aristocracy in our esti- mation—to assume a lofty attitude, can it seem strange that your whole deportment and bearing should correspond with 4 such natural and acquired advantages ? Nor is this elevated and envied position peculiar to yourselves; for the history of our University, during almost a century, furnishes irresistible proofs, in the character and standing of its pupils, of the truth of what I have advanced. You now present yourselves before the trustees and aca- demical and medical faculties of the same University, and in the midst of this large and brilliant assemblage of our citizens, in a new character, a character of your own creation, having won for yourselves the highest honours and privileges any university can bestow; privileges the more endeared to you, we trust, from having been previously conferred in so many instances upon your fathers, preceptors, and friends; privileges of equal value, we hope and believe, with those of any other institution in our happy and much favoured land; privileges to which by com- mon consent we are acknowledged, at home and abroad, to have a full and equitable claim. You will soon appear in this new character and be settled among relatives and neighbours and friends, or be separated from them, perhaps, and tarry among strangers at a distance from your homes. In either case, I trust the admonitions I am about to offer, will be received in that spirit of kindness intended on my part to be conveyed. In the first place allow me to remind you, that although your efforts have so far been crowned with well merited success, you are not to suppose you are entitled to recline with languid supinity, upon the downy bed of indolence and ease, and make no farther exertions for elevating yourselves to that exalted height in the profession, to which every intellectual and high spirited young man ought naturally to aspire; a height which can only be reached by activity, industry, and inflexible deter- mination to strain every nerve to raise yourselves by all honour- able means to the summit of usefulness and renown. You well know how often I have endeavoured, in furtherance of these views, to impress upon your minds the importance of intellec- tual education, and more especially of that department of it, the ancient classics, which are calculated, beyond all other attain- 5 ments, not only to facilitate the acquisition of substantial and indispensable information in every branch of the profession, but to furnish a key to almost every modern language, that will enable you to unlock vast repositories of scientific and lite- rary treasures, such as you could not possibly obtain and appropriate to yourselves from other sources. It is not my intention, however, upon the present occasion to demonstrate to you the value of these studies, the proposition being too clear and unquestionable, I am persuaded, to your own minds— deeply imbued as most of them are with a sense of the rich- ness and beauty and imagery and matchless purity and force and grandeur of the classical writers of antiquity—to require any evidence of the kind. But may I not with propriety counsel you, now that you are free from college rules, and about to play a new and important part upon the drama of life, not to abandon, as too often done, the bright and glowing pages of a Xenophon, a Homer, a Virgil, a Horace, and a Cicero, but to devote a portion of your-leisure hours to the perusal of such models of composition and purity of style, as will improve your taste and knowledge, and fit you to become the companions and friends of literary men of other professions, who in proportion as they find you versed in the appropriate studies of the scholar and the gentleman, will not only place a higher estimate upon your^ medical acquire- ments, of which in other respects they are not always competent to judge, but will distinguish you from the common herd of traders in medicine, and influenced by your individual merits, will thereby be disposed to accord to your profession a loftier standard and more elevated rank. And yet we find a strong and growing disposition on the part of some professional men— who from having themselves received the benefits of a classical education should be the last to truckle and pander to the pre- judices of a weak and vulgar populace—to denounce classical attainments ,as unnecessary to students of medicine and phy- sicians, and by proclaiming in language not to be misunderstood, though studiously qualified for the purpose, if necessary, of escape from the positions laid down, that all, no matter how low 6 in society and how weak in their faculties and education, might safely and advantageously drink at the fountains of medical instruction, and speedily be furnished, by listening to a- few oral lessons each day, without reading and without neglecting social pleasures, with such amount of information as will enable the incumbent, whosoever he may be, to receive a diploma and practice with impunity upon every member of the community that may happen to fall into his hands. Will such absurd and monstrous doctrines be tolerated by the great mass of educated and respectable physicians, spread from one end of this continent to the other? Will respectable medical students consent to sit cheek by jowl, day by day, and walk arm in arm with the illiterate crew that such propositions will soon en- gender? Already is the profession crowded to excess, more especially in country places, and in too many instances, by the ignorant and the vulgar, who undermine by various unworthy and even disgraceful means, men too conscientious and respect- able to resort to similar expedients. What then will be the condition of the profession in the next ten years, if medical schools are to be founded upon the principle of "free trade"— if all sorts and conditions of men are to be invited to join the medical rauks? This question can be answered easily by those who have already experienced the baneful effects of being sur- rounded by practitioners and graduates, without education and without a single qualification for the high duties upon which they have entered, having been seduced from their callings in humble life by the specious promises of those who boldly come out and proclaim to the public, that any man who can read, write, and cipher, will be able to make a skillful and accom- plished physician. I should be very sorry to discourage in the slightest degree by such observations, any young man of native talent and of high principle, who from "res angusti dorni" or any adverse circumstances, "Has felt the influence of malignant star, And waged with fortune an eternal war;" And prevent him from engaging in the study of our profession 7 for want of a preliminary education. But such men are " ran nantes in gurgite vasto," and when found are not easily dis- couraged, even when told, authoritatively, that it is " too late" to enter upon the study of classics after the study of medicine has been commenced; especially when they learn, at the same time, that some of the most eminent men in all professions have by dint of hard study and uncommon labour, become accom- plished scholars and adepts in the most abstruse sciences, even after they have attained their seventieth year. I wish I could sa.y it were possible for men without capacity to accomplish half as much; for then 1 should be prepared to admit that every aspirant for medical honours should be welcomed to medical halls, and assimilated with the best and noblest of the land. You yourselves will soon occupy the important position of practitioners, and will be called upon to receive and educate pupils. YvTill you not, then, in assuming the delicate and res- ponsible office of training up youth and fitting them to officiate . and excel in the various duties that will afterwards devolve upon them, see that they are qualified by nature and education, for these high and almost holy purposes? Will you not en- courage them, if they have received a collegiate or liberal education, not to dispense, as is too common, during their medical curriculum, with such accomplishments, but to apply them advantageously and pleasurably, by select and judicious reading of the standard Greek and Latin authorities in our profes- sion, some of which are scarcely inferior to the bost poetical and prose compositions of the ancient classical writers ? Or where they happen to be deficient in these preliminary studies, will it not become your duty as well as pleasure, to assist them by per- sonal attention, or to refer them to competent teachers for in- struction, so that when they enter upon a course of lectures they may be prepared to understand, at once, the etymological import of every phrase, and to acquire with the least possible amount of labour, a knowledge of terms which are often so embarrassing to the student, from his inability to derive them, and by burthening his memory to repletion, as sometimes to overpower even the strongest uncultivated minds ? 8 A mighty revolution within the last few years has overspread the face of this great country, and is rapidly but peace- ably extending its benign innuence to the uttermost ends of the earth. Need I say that I allude to the glorious cause of temperance, which with the expanded wings of an angel is now hovering over myriads of human beings, shielding them from the fierce assaults of that fiery and malignant demon, who for ages past has walked almost unopposed through the ranks of society with gigantic strides, and scattered death and desolation with an unsparing and unmerciful hand to all, with- out the strength and courage to resist his attacks. May I not appeal to you as the young and rising guardians of that noble profession, only second in importance and influence to that of the ambassadors of the living God, to sow and water the seeds of that plant of mercy still so much needed for sustenance, until by its vigorous growth, it shall be able to blossom and send forth abundantly its nutritious and wholesome fruits, to every nook and corner of our blessed land ? Admonitions on this sub- ject, coming from most other sources, too often prove weak and valueless; but who, however callous and case-hardened he may be, can listen to the appeals of " the beloved physician," when he details the slow but sure effects of that deleterious poison, poured day after day and night after night, into the inmost re- cesses of the vital organs, inflaming their substance, paralyzing their actions, impeding their excretions, and drying up, by a peculiarly corroding and blighting process, the very fountains of animal existence, when he pourtrays in vivid colours, upon the broad canvass of truth and reality, the horrible sufferings of some unfortunate and wretched being; a prey to the keenest anguish of soul and body; the victim of frightful hallucinations; haunted by the most distressing and appalling objects that can be presented to the imagination; pursued by evil spirits in the shape of demons, and realizing the tortures of the damned, through a combination and assemblage of symptoms, embodied under the well known, but not sufficiently expressive name, of delirium tremens; a disease which, sooner or later, is almost sure to terminate in convulsions and death ? Who, I ask, can 9 have such a picture, faithfully drawn and accurately coloured by a skilful medical artist, held up to his view, without shrink- ing with horror and dismay from the dreadful scene, and without resolving from that moment never to suffer so refined and subtle an ingredient of the chalice of human misery, to enter his lips or the portals of that threshold, which, as the sanctuary of the partner of his bosom and of the innocent pledges of connu- bial love, should be kept inviolate from the tempting influence of even a common foe? Knowing, then, the power you will possess over the minds of your patients and friends, over whole families entrusted to your care, over communities, which per- haps, the persuasive voice of reform may never yet have reached, will you not have the moral courage to step forth, as the champions of health, of order, of morality, of religion, as the friends of the poor, the unfortunate and distressed, and drive from one and all of them, by your example and counsels, an evil which has been productive of more crime, wickedness and wo, and has consigned to want and to the tomb, more fami- lies and human beings, civilized and savage, old and young, from the highest to the lowest, than were ever sacrificed by pestilence or the sword ? I will answer the question, by saying, I am sure you will; that sooner or later, I am sure you must; that your own convictions will lead you. to it, that public senti- ment will drive you to it; that at no distant day, every people and every nation will join you in it; and then, that a temper- ance millenium will preside over and reign throughout the world. Suffer me to draw your attention to other subjects. It has been said, that members of our profession, like poets, belong to to the irritaWe race; and it must be confessed that, in many instances the odium medicum has waxed stronger and been pushed farther, than amongst any other class of literary men. I will not stop to inquire, minutely, into the extent of this malady, its causes or method of cure, but shall observe, that for several years past, the disease appears to have been on the de- cline, and is now seldom seen except amongst hot and rebel- lious graduates fresh frorn the schools—the older practitioners B 10 having long discovered, that patients generally avoid squabbling doctors, and seek out some gentle and unpretending physician for their own use. Let me advise you, then, in commencing your medical career, to set out with the principle to devote yourself exclusively to your profession ; to engage in no amuse- ments calculated to lead you from it; to enter into no political or other associations likely to produce heart-burnings or ani- mosities ; to be upon very kind terms with your neighbours and patients; to use no harsh language towards any one, however great the provocation; to believe every one innocent until you prove him to be guilty; and above all, to cultivate a good un- derstanding among members of the profession, whom you have reason to think upright and honourable, and never condescend to mention, or notice, in any shape, such as you know to be unworthy your acquaintance and regard. Twenty or thirty years ago there were very few medical men in any of the large cities of the Union upon good terms, and the same observation will apply to country practitioners; but a revolution has been slowly brought about, so that it would be now more difficult to discover enemies than friends. In all communities, of course, there are outlaws in the profession, whom it is impossible to control; but these are, generally, avoided by all prudent and sensible men, and at last sink in public estimation or are for- gotten. I have no personal allusions in such statements; for characters of the kind are peculiar to no place or country, but are to be met with in every part of the world. I cannot speak from personal knowledge of most of our large cities; but from what I know of this community, I feel warranted in asserting that, with very few exceptions, there is as much harmony and good fellowship among the whole corps of medical men, old and young, and even where their interests are really, or seemingly opposed, as in any city of the world. Especially am I sure, that the rising generation of medical men here, are associated with each other like a band of brothers; and that the same spirit is rapidly pervading every other medical community. And why should it not be so ? We are struggling nobly for the advancement of our science, which in too many instances, 11 has suffered from the tricks and devices of quacks and pre- tenders, and has been degraded even in the estimation of intel- ligent persons. Should difference of opinion or opposite modes of practice, engender a spirit of warfare and hostility? Cer- tainly not; for if opinions should remain unchanged, there must soon be an end to improvement. Are our interests not the same ? undoubtedly they are ! How then can they be pro- tected, unless by the general co-operation of the whole medical corps; and how can unanimity prevail, except through the me- dium of personal respect and affection—especially as the laws of the country, instead of protecting and sustaining the profes- sion, cause it to be overrun by broods of vagabonds and impos- tors, dissolute and abandoned enough, in many instances, to corrupt even the inmates of a penitentiary. Most young physicians and surgeons commence practice, and perhaps take a deep interest in the fate of each patient, and labour unremittingly in their vocation, but without making the slightest record of their cases, however interesting, obscure, and complicated they may be, or of the remedies they have found most useful. Than this there cannot be a greater mistake, as they will find in after life, sorely to their cost, when obliged to make frequent demands upon their memories and to call up facts and circumstances, which, if they had been accurately de- tailed and registered, would not only have proved highly inte- resting, but of the greatest advantage to themselves and perhaps to the public. In Europe the practice of recording important cases and observations has long been almost universal, and there has seldom been a great physician or surgeon in any age but has written down carefully with his own hand important events in his practice; and so indispensable is the custom of preserving such documents considered, that it is one of the foremost duties of pupils in hospitals to write down exact statements of every case, which are open to the inspection of all that attend upon the lectures and practice of these institutions. Indeed, the hos- pital physicians and surgeons have, in numerous instances, availed themselves largely of the labours of their pupils, by publishing in detail many of their cases with suitable comments 12 and explanations. This will account, in a great measure, for the immense mass of facts accumulated by eminent European writers, and communicated to the public in the shape of large and splendid volumes. The writings of both the Bells, of the Coopers, Abernethy, Hey, Lawrence, Brodie, Guthrie, Cramp- ton, Carmichael, and indeed of all the great British surgeons, as well as French, German, and Italian, are convincing proofs of the vast importance they attached to the preservation of facts, and how much use they made of such materials in eluci- dation of their various doctrines and pathological explanations. A late eminent surgeon of this city once lamented to me bitterly that he had not kept a regular case book, and acknow- ledged with extreme regret, that he had forgotten thousands of cases the preservation of which might have proved a public benefit. Let me conjure you, therefore, by the love you bear your profession, and by the value you place upon your own reputation and future prosperity, to commence with the practice of carefully noting down every important case and observation; a practice, I venture to predict, you will find, after a few trials, attended with so little inconvenience, and fraught with so many important results, as to feel disposed to continue as long as you live. Those of you who may settle in remote country situations or in the smaller distant towns, will often experience the inconve- nience of not being able to keep up with improvements in your profession, owing to the difficulty of obtaining recent publica- tions and standard works. To compensate for this deficiency, let me advise you to make arrangements for the regular recep- tion of periodical journals, several of which of sterling value issue from various sources in our country, and have a reputation abroad not inferior to the best foreign publications of similar character. I cannot avoid calling your attention particularly to one publication of the kind, which, more than twenty-five years ago, under the auspices of Professor Chapman, was ushered into existence, and has since sustained, through the able man- agement of Dr. Hays, an unexampled reputation throughout the country, and is eagerly sought after in Europe as the highest 13 professional authority of our land, and as second to none of their own productions—as I had opportunities of knowing during my visit abroad four or five years since. As you will always take, I trust, a deep and abiding interest in the prosperity and glory of that alma mater, from which you lave this day received insignia and honours that cannot fail to marshal you forward on the road to fame, it will be a pride and satisfaction to you, I am sure, to learn that her ample resources and opportunities for propagating information in the various branches of medical education entrusted to her care, not only continue unabated but are improved and strengthened every successive year. Setting her face, as she always has done and will continue to do, against unworthy and insidious means, her object ever has been to elevate the standard of the profession to the noblest height—avoiding as mean and dishonourable, "the levelling system, the pandering to popularity, mock examina- tions for degrees, the formation of fictitious catalogues," and other offences recently charged in some of our journals against medical schools. You yourselves can bear ample testimony in her favour on this point. But lest a shadow of doubt should remain in the mind of any individual, whether belonging to the profession or the public, I may state that our class, during the course of lectures just ended, amounted to four hundred and eleven bona fide students, forty-eight graduates of medicine, and five clergymen, including theological students, making in the aggregate four hundred and sixty-four—the largest class ever assembled in the University with the exception of the year 1817, when the number of matriculants was the same, and the year'l824, when four hundred and eighty-seven attended the school. Thus it appears, so far as data have reached us—even conceding that all the published catalogues are true and faithful exponent's of the condition of each school-that the class of genuine students in the University of Pennsylvania, during the session of 1845-46, was the largest in the United States. Whilst on this subject, I may further remark, that in the midst of a population of several hundred thousand persons, which furnishes such ample material for eliciting a matriculating list, « 14 the latter must be a very imperfect index or exponent of the state of a school, unless regulated by certain restrictions. We have therefore to say, that our published list of this session is strictly an escpurgata one, and presents a fair exhibit of the relation of each name to the institution—no name having been placed upon this catalogue which had not been previously in- serted in an inscription book under the supervision of the dean, in the handwriting of the individual himself, or in a manner equally authoritative and decisive in regard to his connexion with the school. I may also state, that the physicians and a very few other persons attending upon a general permit, have been marked out and summed up, so as to establish the distinction between them and the body of the class—that no tickets have been gratui- tously distributed by professors or others under any designation whatever, that they might afterwards be added to the matricu- lating list to augment its number; that no simple contribution of names has been made with the same view; that no youths engaged in a course of elementary education in common schools, have been reported in the catalogue as medical students; that in keeping the catalogue clear of all such accessories which may have been blended with it, the position of every individual has been fairly defined and fixed; that the post town or post office of his neighbourhood has been reported, as well as the name of his preceptor; it not being considered sufficiently explanatory, now, by the public to designate an individual merely by the state in which he may be said to reside, but by localities and circumstances to be ascertained by any one who may desire to learn his exact habitation; nor as affording to others corrobo- rative evidence of good faith on the part of those upon whom the responsibility of making out a catalogue devolves. We, of course, do not pretend to dictate to other schools, the mode in which their catalogues shall be presented to the public; presuming that each school will pursue its own plan, in accord- ance with the views or policy most congenial to itself; but as the formation of such documents has become, recently, a sub- ject of inquiry and of animadversion by journalists and others, 15 we deem it a duty to ourselves, to put forth this disclaimer of any irregularity on our part, and wish it to be distinctly un- derstood by the alumni and friends of the University, that its matriculating list is preserved under such restrictions, as to make it always a true and faithful report of the actual condi- tion of the institution, and that it must be judged oiperse, and by the principles upon which it is formed. I may further remark, that our list of graduates now is, and always has been small, compared with the large number of students attending the school. This depends, there is reason to believe, upon a rigid adherence, on our part, to the regulations made by our trustees for the government of the school, and upon the system of discipline pursued throughout—a system which, however well it may work with the educated, intelligent and industrious student, is certainly a terror to the idle, the dis- sipated and the ignorant, and calculated to drive them in shoals to such places as they hope and believe will furnish them with degrees upon the easiest terms. The celebrated Dr. Parr, in reply to one by whom he was twitted and taunted, upon the strictness of his discipline, remarked : " Yes sir, discipline is a good thing; 'tis discipline that makes the soldier, discipline that makes the sailor, discipline that makes the scholar, discipline that makes the gentleman, and the want of discipline that makes you what you are." To this I may add, that discipline has made your alma mater; that discipline has made the students, the gentlemen and the graduates belonging to her; and that when she loses her discipline, she will lose, and deserve to lose, her reputation and her life. With discipline are necessarily asso- ciated principle and consistency. " Lead is too soft, as well as too worthless, to be stamped into coin and currency. You cannot polish a fungus or a sponge. Solid bodies only can admit the process; and the firmer they are, the better will they shine."* I have taken up, my young friends, more of your time than I intended, and will, therefore, conclude by entreating you to * Jay's Evening Exercises for the Closet. 16 believe that we shall all ever feel a very sincere and affectionate interest in your welfare and prosperity; and that, hereafter, when the names of many of you shall be emblazoned on the rolls of fame, it will be with pride and exultation we shall re- member you as our pupils and as sous of the University of Pennsylvania.