VALEDICTORY TO THE GRADUATES # OF RUSH MEDICAL COLLEGE, CHICAGO; ILLS. By G. N. FITCH, M. D., PROFESSOR OF INSTITUTES AND PRACTICE OF MEDICINE. CHICAGO : William ellis, book and job printer. SALOON BUILDING. 1847. VALEDICTORY / TO THE GRADUATES . OF RUSH MEDICAL COLLECT, CHICAGO, ILLS. By G. N. FITCH, M. D., PROFESSOR OF INSTITUTES AND PRACTICE OF MEDICINE. . CHICAGO: WILLIAM ELLIS, BOOK AND JOB PRINTER, SALOON BUILDING. ' ✓ 1847, Chicago, February 19, 1847. Prof. Fitch : Dear Sir,—At a meeting of the Class of Rush VIedical College, held on this day, Mr. L. L. Lake, of Illinois, being in the chair, and Mr. PI. P. Howes, of Indiana, acting ai Sec- retary, on motion, it was unanimously Resolved,—That a committee be appointed to solicit, for publication, a copy of your able Valedictory Lecture, ed on Thursday evening last. The undersigned having been appointed the committee \> perform this pleasant duty, allow us to add our individua wishes to those of the Class, and to hope that you will not re- fuse so unanimous a request. We need not assure you how truly we are yours, See. R. P. LAMB, of Illinois. T. C. MOOR, of Indiana. W. PIERCE, of Illinois. S. W. LOVELL, of Michigan. J. H. COOPER, Wis. Ter. Chicago, February 19, 1847. Gentlemen : Such as my Valedictory is, it is at your disposal. It was hastily written, has few claims to originality, and yet, although the sentiments have been mostly drawn from memo- ry, I do not recollect to whom I am indebted for them with few exceptions, and am therefore unable to quote them cor- rectly or give the proper credits. Respectfully, yours, G. N. FITCH. Messrs. R. P. Lamb, T. C. Moor, W. Pierce, S. W. Lovell, J. H. Cooper, »Committee. VALEDICTORY. Gentlemen : The relation, hitherto, for a short time subsisting be- tween us is now to be dissolved. You are going forth into the world to test the correctness and utility of those professional practices and precepts which we, as your teachers, have en- deavored to inculcate. You are going forth as Graduates of Rush Medical College to hold its Faculty, as will the public, indirectly responsible for the results of your profession- al acts. It is a fearful responsibility: for you go forth armed, more than any other class of men, with instruments for good or evil, for life or death, according to the judgment and skill with which they are wielded. Yet it is a responsibility, which from our knowledge of those for whom it is incurred, and from the ordeal through which they have passed under our imme- diate eye, we unhesitatingly assume. A custom so long observed as to have become incorporated with, and constitute a part of a system of medical education, requires us in this, our final and parting interview in the rela- tion of teacher and taught, to briefly sum up your duties to yourselves, your profession, and the communities of which you may hereafter severally become members. The duty which this custom entails has devolved upon me, and, though conscious of a deficiency in the qualifications requisite for its proper discharge, yet shall I cheerfully undertake it, under the full conviction that the observance upon your part of the pre- cepts 1 shall lay down for your guidance, will redound alike to your moral and professional reputation and that of the school from which you derive your diploma. In your future course you will be answerable to two governing codes, which in no manner conflict with each other, a medical and a moral; with both of which your deportment must harmonise if you desire to take respectable rank in your profession. Among the most important requirements of the former is the one to study. Greatly to the discredit of our profession, and much I fear to%the detriment‘of those seeking its assistance, is this requirement neglected. Every student when about entering upon the acquisition of a knowledge of medicine, should do so with the full understanding that the application of a life time will no more than suffice to familiarize him with the vast field of science he is required to explore. “To excel in this pro- fession requires a greater compass of learning than is neces- sary in any other.” Every thing appertaining to the sciences which it is permitted the range of human intellect to embrace is of importance to the physician—may aid him in diagnosti- cating disease, or in applying the appropriate remedy. His daily avocations require an acquaintance with anatomy, mor- bid and healthy, with physiology, and the laws of disease; with chemistry in all its vast and varied relations; and with the multiplied objects which botany presents for investigation. He must recognize nature in every form; be intimate with its normal laws to detect deviations from them. And he must direct all this knowledge to the discovery and application of the proper means for the eradication of disease. There is no short road to its attainment—no man imbibes it intuitively. The recorded experience of centuries must be perused— the opinions of the many who have preceded us be com- pared and digested. Months will not suffice for this; nor years—nor scarce “tens of years.” Study then, for you have not only all this but much more to learn. Your co- temporaries throughout the world are bending the energies of giant intellects to the elucidation of the much not yet understood in our profession. If you do not study, how are you to avail yourselves of their additional knowledge—or how your patients to be aided by their beneficial discover- ies ? Never plead in justification of a want of studious ha- bits, the acquisition of your diploma. Its possession is well said to be no evidence of your having traversed the “ temple of medical science—only of having entered its portals.” Aside from other considerations, self interest should instigate you to studious application. If you are content for years with a rou- tine practice, oblivious perhaps of the circumstances under which you first adopted it, and of the symptoms which in your estimation first required it, you are in danger of resorting to it from mere habit, even when clearly not indicated. This “ ha- 7 bit” then will usurp the place of knowledge and judgment, and you will be enabled to alledge no better reason ft>r a course, the results of which circumstances, not skill, controlled, than that it was the recommendation of some remote predecessor. It is obvious that any more mentally industrious competitor, who shall keep pace with medical improvements and discov- eries, will be more successful and soon supplant you. Can the supposition be for a moment entertained that a man would be recognized as possessing any professional claims who should neglect or refuse to adopt the practical suggestions clearly de- ducible from the discoveries of Harvey, Jenner, Hunter, and others of more recent date and nearly equal importance, and thus practically admit his ignorance of them ? It may be said the supposed case is an extreme one, the discoveries alluded to made many years since, and hence all having any preten- sions to medical knowledge must be presumed to be acquaint- ed with them. True, yet the principle is the same. If they were made to-day by some of our present ardent medical in- quirers, and published to-morrow or next year, as others equal- ly valuable are liable to be, you would not desire to reach the termination of a long professional life in ignorance of them, and perhaps preceded to your final bourne by many of your patients in consequence of that ignorance. Let me repeat the injunction then to study—but not books only. Nature is truly said to be the great first teacher of medicine. It is a book al- ways open for study, and one with which of all men the phy- sician requires to be the most intimate. Observe closely the effects, not only of your medicinal remedies, but also of any hygienic and moral means you may direct, and deduce cor- rect inferences from them, that you may be ever after prepar- ed to renew benefit or avoid error. Experience is too often presumptuously arrayed in defence of erronious treatment, or in opposition to that to which a discriminating judgment points as correct. With the necessary theoretical knowledge, con- stantly refreshed by study, experience aids materially in its application ; but without this knowledge it is a fallacious basis for medical practice, not enabling one to distinguish an escape from a recovery, an unfortunate result consequent upon dis- ease, from one induced by treatment, and lienee leading to a constant repetition of error. Very many physicians whose 8 theory—whose analytical knowledge, was even too limited at the commencement of their career, add nothing to it subse- quently. Either their ignorance and its accompanying pre- sumption lead them to overlook the necessity of study, or their mental indolence persuades them to neglect it, and per- sonal experience becomes their sole guide. They will thus darkly grope their way through along life, becoming annually more ignorant of their profession “as they acquire no new knowledge and forget much they had once learned.” You will find the observance of certain general rules desir- able in your intercourse with your professional brethren if you would secure their respect—and their respect, permit me to say, is necessary to enable you to take high rank in the esti- mation of the non-professional public. Never give a moment’s abiding place in your bosom to envy of a cotemporary. If there must be competition between you, let it be of that en- nobling kind, which, while it binds you together as personal and professional friends, instigates you to bend all your ener- gies to the farther acquisition of such knowledge as will enable you to attain to superior excellence in the discharge of your peculiar duties, and hence to increased patronage. The means of acquiring such knowledge is open to all. If one avail himself of them to greater extent than another, it should be no cause of envy, but rather of commendation. If another exceed you in prosperity and success, never attempt to de- tract from his merit, nor indulge in envy of him. A man ad- mits inferiority by manifesting envy, for he envies only that which he ardently desires, but does not possess, and which had he the ability to acquire he would soon obtain. Then praise the success while you endeavor by renewed applica- tion to equal it; and congratulate upon the prosperity which you will have reason to believe will soon be within your reach. “When doctors disagree” has passed into a proverb; and truly the disagreements of the profession are lamentable! Not those relative to the application of some particular rules of practice,—but disagreements of a personal nature origina- ting in pofessional jealousy. Ill feeling thus engendered, however, too frequently seeks to injure its object by profes- sional slander. We are accused of more bickerings than any 9 other class of men, and the accusation is undeniably true. This has been supposed attributable in part to the fact that our knowledge and professional character generally form our sole capital, and hence an attempted injury of the one, or de- nial of the other, is looked upon as an effort at a species of robbery. It is to be feared that much of it arises from the admission among us of unworthy members—men who look more to pecuniary consideration than to professional or moral character; who are wanting in those noble qualities which lead to the acknowledgment of merit wherever found, and deter from efforts to establish their own reputation by attemp- ting the destruction of another’s, for the purpose of acquiring the patronage previously bestowed upon him. We condemn, morally and legally, the man who by false beacons entices a ship upon hidden rocks by which it is wrecked, that lie may plunder a part of the scattered cargo; and why shall we not equally condemn the professional man who seeks to wreck a reputation that he may possess a share of the patronage it had acquired? The presumed propensity of the profession to en- gage in a “war of words,” is often made available by those out of it in their efforts to injure some one of its, members, against whom they may allege fancied or real cause of griev- ance. In furtherance of the object of such “efforts,” they seek, by devisal of some tale, to excite against him the prejudices of cotemporaries. You should, hence, ever be slow in giving credence to any derogatory remark represented to have been made by a professional neighbor. It may have been coined by the reporter for his own purposes, or so embellished in the repeating as to give it all it possesses of an offensive character, and even if not so, it is far better you should pass it by un- heeded. If you cannot escape invidious remarks, you can at least avoid making them. If those indulging in them towards you find your reputation too firmly established to be thus as- sailed successfully, and themselves meeting only your silent contempt, their efforts will soon cease. And how much bet- ter so than for you to retort, and thus engage in crimination and recrimination, ending perhaps in newspaper appeals to the public, which disgrace both parties and discredit the entire profession. You will often be required to be parties to consultations, 10 which impose peculiar duties upon you. You can never re- fuse to call them when requested so to do by the patient or friends: but unless otherwise desired by those more imme- diately interested, seek council only of one or two of your most judicious professional neighbors. A numerous consulta- tion is never attended with any benefit at all proportionate to the number of councillors, but rather the reverse—the old pro- verb to the contrary notwithstanding—for each one becomes engaged in advancing his peculiar notions, discussing some theory, or stating a case, and the one which should be under consideration is lost sight of. In calling consultations upon your own responsibility, two extremes should be avoided. If you are satisfactorily convinced of the nature of the disease, and confident of a probable favorable result, no necessity ex- ists for a consultation, and you should yield to no idle fear of your own, but endeavor to allay any entertained by the friends, and not call one, for by so doing you give undue im- portance to the case; you may so alarm your patient as to aggravate his symptoms, producing danger where little was to be apprehended before. On the contrary, entertaining reasonable doubts of the character of the disease, or of the propriety of your course, do not delay a consultation until its only result must be a verdict of death, by fair or foul means, that event being certain. When errors in practice fall honor- ably under your notice (as in consultations), it is your duty to express your conviction of the same, and to point out the proper course, in your estimation, to be pursued. But let it be done to the entertaining such error, and to no other persons. Moreover, let it be done at such time and in such language as that the manner shall be no cause of offence; the fact constitutes no reasonable ground for difficulty. In truth the one entertaining such errors will best exhibit his sense by thanking you for calling his attention to them. There are few “statutory” provisions in any of the States relative to medical practice, and no legal special recognition of our profession; hence “ Quacks,” in the language of Ryan, “ are allowed to flourish to an illimitable extent, and destroy more than sword, famine, and pestilence united.” You may be requested to visit some invalid under torture by one of this in consultation with him. You must not comply with 11 the request. The reasons are obvious. The man with whom your are desired to consult in a grave matter, involving no less than the life of a fellow being, is profoundly ignorant of the mechanism of the machine, the human frame, with which he has been tampering; he knows nothing of the laws of vitality, and but little of the effects of agents upon the organs moving in obedience to those law's; he is therefore profoundly ignorant of the first principles which should govern him in the management of disease. If you attempt the correction of error, he will not admit its existence. If you direct the appli- cation of proper treatment, he will not permit it if in his pow- er, insidiously or otherwise, to prevent it. He will substitute effrontery for knowledge, abuse for reason. You will, by re- fusing to meet such men, best retain the respect of the more intelligent public, and what is perhaps of more importance, you will thereby best retain your self-respect. Men have vari- ous assailable points—one can be gulled by means which, if brought to bear upon another, would prove entirely unsuccess- ful. Hence this class (quacks) is found variously divided, some resorting to one scheme, some to another, all aiming at the same result—deception, by holding out the seldom real- ized |lfospect of health to the invalid from the use of their panaceas, or pursuit of their “patent” plans. They are found therefore arrayed under the banners of the leaders of different divisions of medical humbugs. But they all usurp our name, “Doctor”; each attaching some prefix to it indica- tive of his particular manner of humbugging. Some adminis- ter the “shadow of a shade,” or other article equally active medicinally, permitting the disease to do as “ unto itself seem- eth best” with the patient, and crying out “actio Dei” if he dies, and “actio mei” if he recovers. Others endeavor to drown the disease by merely a degree less than drowning the patient; and others again will cook his cuticle in efforts to force through it the embodiment of his malady in the shape of swreat! They all steal our livery in taking our professional name, but the lion’s hide will illy conceal their ear-marks. You w'ill protect yourselves from annoyance from this class by refraining from all intercourse with them; and tins protection, together with that afforded you by your superior attainments and success, is all you need require. It is better for us pro- 12 fessionally that we have no statutory protection, that no legal recognition of what shall or shall not constitute medical prac- tice, exists. We might be disposed to seek shelter under it, relying upon that and not upon qualifications to secure pat- ronage. Hence never seek by petition to law makers, or other- wise, the enactment of such statutes. If protection from them is needed, it is by their dupes, the victims of their avaricious ignorance, not by us. Society frames laws for the punish- ment of the highwayman who boldly demands a man’s purse or his life, but permits the quack, who under false pretences first obtains hi§ purse, and next too frequently takes his life, or at least destroys all inducement for desiring it by robbing him of health, permits him to go abroad unrestrained. If you desire to see a criminal code include their acts among other crimes, you can only entertain such desire as a member of soci- ety ; as a member of our profession your pecuniary interest is advanced by permitting them to go at large. For what phy- sician is not daily required to prescribe for diseased conditions induced or highly aggravated by some emperic’s nostrums? If disease be, as is said, the physician’s prey, the quack is his jackall! Never undertake the management of a case upon the prin- ciple of “ no cure, no pay.” A man who would request it would be very likely to feign continued illness to avoid pay- ment. You may be sanguine of your ability to effect a cure, but you cannot anticipate or provide against circumstances which will prevent it; perhaps the supervention of another disease, or some imprudence of your patient. Hence you must in all cases where the patient has the ability7- to pay, in- sist upon a compensation for your services. Your professional knowledge is your capital, and you are as much entitled to a consideration for its exercise as is the merchant for his wares, the farmer for his produce, or the mechanic for his labor. You constitute no exception to mankind, you must have “ where- withal for the inward man,” aye and outward too; and for the discharge of debts, if unfortunately you have contracted any, (which 1 recommend you not to do if you value your peace and independence,) and whence are you to derive the necessary means, unless from those for whose health and com- fort your professional skill has been exerted? If you are 13 doubtful of your ability to reestablish a patient’s health, frank- ly state your doubt. If the presence of a doubt, prevents him from submitting to treatment, he assuredly can have no hope of recovery, for he uses no means to ensure it; if he places himself under your care, it is to he presumed you exert your- self to the utmost of your ability in his behalf, and a failure to radically cure him, either from the nature of the disease, some sudden complication, or his own imprudence, forms no valid plea in bar of your demand for payment. Were it an arti- san’s task you were about undertaking, where material and instruments were alike passive in your hands, alike under your control, there would he perfect propriety in engaging its com- pletion before receiving any equivalent. But here the case is different. You know the effect of your agents—your reme- dies—upon the average of mankind, both in a normal and morbid condition, hut you know likewise that this effect is liable to he retarded, lessened, varied, perhaps prevented en- tirely by some idiosyncrasy of the patient, by some latent dis- ease, or by some one of the many varying circumstances of diet, exercise, air, habit, &c., surrounding him. Had you the disease only with which to contend, an almost uniformly fav- orable result would be attained ; but when so many collateral aids are called in defiance of your skill, the only matter of sur- prise is that such result follows even in a respectable number of cases. The greater the confidence of the public in the med- ical profession, the greater are the benefits the latter can bes- tow. Such bargaining as I have mentioned deprives the pro- fession of its character, as such, converts it into a trade. It degrades not only the member engaged in it, but so far as the acts of one can do it, it degrades the entire profession, robs it of the confidence of the public, and materially lessens its ca- pability of usefulness. Never betray by word, act or look, of a delicate domestic, or personal nature, which has come to your knowl- edge, professionally. Such conduct will, as it should, con- demn a medical man to lasting contempt, not only in the esti- mation of the injured, but of those who, for base purposes, may have encouraged such betrayal of direct or implied con- fidence. You may be the “ family physician,” and as such, considered almost a member of the domestic circle, one who 14 would defend its hearth and fireside. What should be the mea- sure of punishment meted to one for betrayal of trusts of which he had thus become the depository? You will often be con- sulted upon matters involving health, connected with circum- stances of a delicate nature, and where, perhaps, not even an impropriety upon the part of your patient is involved, yet which if bruited abroad, would outrage their feelings, or operate to their injury. Such trusts must be sacred, though the confi- dence may be implied. Let no consideration induce you to impart a knowledge of them to others. Even should your patients prove recreant to all sense of gratitude, and be found thereafter arrayed among your personal and professional op- ponents, (and who has warmer friends or more bitter foes than the physician?) that fact must not make you forgetful of the duty you owe yourself and the profession, and induce you to seek revenge by betrayal of professional trust. Erroneous and improper motives may be attributed to your refusal to gratify the curiosity of the inquisitive, or malice of the evil dis- posed, by a disclosure of professional secrets at which they wish to arrive ; but let no desire to correct misconception of your motive, or allay clamour against yourself, induce you to such betrayal. Ultimately friends will be acquired to you by the maintenance of professional integrity. Your motives will be appreciated and honored. This injunction of secresy is not to be understood as extending to crime, involving hap- piness, property, or life of others. In such cases your duty to society will clearly point to the necessity of preventing the commission of crime, mitigating its consequences, or securing its punishment. Be prompt in your attendance upon patients. You should permit nothing but other urgent calls to interfere with the ful- filment of your professional engagements. Up to the time of your promised return, the sick will submit to your absence with some degree of patience, but every hour’s delay beyond, is an age of suspense and torture to them. The intense anx- iety with which an invalid awaits the momentarily expected visit of a medical attendant, upon whom he has fixed his confi- dence, centered his hopes, perhaps of recovery, becomes at times really painful; incredibly so, except to those who have experienced it. It cannot but exert as prejudicial an effect 15 upon the disease, as his presence is well known to exert the reverse, aside from any medical treatment. A too frequent or constant attendance is, however, except in extreme cases, by no means desirable. A change, favorable or otherwise, indicating a modification of treatment, might then occur so gradually as to escape your notice; whereas by retaining a recollection of your patient’s condition at a previous visit, and comparing it with what you find at a subsequent one, the change is detected. Identity yourself with your patient’s physical welfare; feel a personal interest in their recovery. And you need not fear to evince it. It is honorable. It will increase their confidence. Very few sick care to entrust themselves to the charge of a physician who feels or feigns an indiffer- ence to the result, except perhaps in so far as recovery or death would detract from or exalt his reputation. At the same time your feelings should not be permitted to blind your judgment. You must early learn perfect command of voice, manner and countenance, even under circumstances of most appalling danger to your patient. A betrayal in any manner on your part of imminent fear of a fatal result, will often en- sure it, by depriving the patient of the stimulus of hope; while a calmness, even an appearance of cheerfulness by you, so long as a reasonable expectation of recovery can be entertain- ed, will instil hope, beget confidence, where without it, all will be doubt and fear—will encourage to a perseverence in treat- ment, where otherwise the patient in despair would refuse farther aid. There are other matters not specially pertaining to your profession, and consequently of importance to you only in common with all citizens, but yet a due regard to which has such direct influence over your future success, that your atten- tion may well be called to them in this connection. You must ever bear in mind that the qualities necessary to constitute the good physician, are incompatible with the absence of those entitling one to take rank as a good citizen and gentleman. Skill in your profession will avail little if accompanied with obtusencss or obliquity of moral vision; for the latter, by depri- ving you of the respect of your fellows and confidence of the public, will forever preclude you from a fair field for the de- velopment of the former. Your professional, then, is some- what dependant upon your moral, character. I have briefly stated a few requisitions which will be necessary to enable you to establish and maintain the former, presuming you to be familiar with the conditions demanded for the latter. Keep these conditions ever upon your mind; not as legal enactments arc too often learned, for the purpose of ascertaining what de- viation from moral right is not legal wrong, punishable by pains and penalties ; not for the purpose of being dishonest “accord- ing to law,” but that you may always recognize right and adopt it as your rule of action. Among the conditions of the most momentous importance, which are collaterally necessary for your professional success, is “temperance in all things.” I am not about inflicting upon you a stale temperance speech. As medical students you are presumed to be aware of the ter- rible train of evils, moral and physical, which follows habits of intoxication. It is, in truth, from the observations and re- searches of our profession that are drawn the strongest argu- ments against this habit. Then what should be thought of the physician who contracts it? If it is an offence in others, it is a crime in him ; for to a recklessness of individual and do- mestic consequences, he adds an indifference to, a disregard of the lives of those who may be dependent upon his profess- ional services. You may be told that certain physicians are as skillful when intoxicated as when sober; rely upon it, such men are void of skill at all times. Chance or routine may make them at times successful, but the success is not dependent upon the exercise of any judgment. We know that mental excitement deprives a man of that coolness of judgment and promptness of decision, often so necessary in the physician; and how much greater the disqualification, when the excitement is produced by a cause which either stultifies or renders utterly reckless! Carefully, then, avoid the ap- proach, aye even a suspicion of the approach, of a habit of in- dulging in spiritous or opiate. It may well be sub- mitted to your own decision whether another too common habit can be productive of other than evil to yourselves and those with whom you associate—I mean the use of tobacco. From the character of your studies you are known to be inti- mate with its properties and effects. If you are found indulg- ing in its use, the legitimate deduction upon the part of those 17 wanting other means of information relative to it, will be that some peculiar benefit is attainable therefrom. It will be in vain for you to declare the contrary and plead habit as your only defence for its consumption. Unless your practice ac- cords with your precept, you will find rhany more adopting the former than heeding the latter. You will thus by your example be encouraging the use of an article which you know to be a deadly narcotic poison, incapable under any circum- stances, except in some rare cases of extreme disease, of im- parting any benefit at all commensurate with the positive evils which result from its continued use. There are other addi- tional reasons why you should avoid this habit. Of all men, you will most frequently have occasion to visit the domicils of every class of society. If in some an example of cleanliness is needed, in others you must yourselves observe that virtue, to make a repetition of your visits desirable or welcome ; and in none should the example of the “family physician” be plead in justilication of a want of its observance. Moreover, every sense which nature bestowed upon you is very often called into active requisition, for the distinguishment of the various properties of your remedial agents ; and why destroy two of the most available, smell and taste, by the constant application to their seat of this narcotic ? The association of these two pernicious habits—use of tobacco and spirituous stimuli—is too frequent to be accidental. That neither one is necessarily followed by contraction of the other, is admitted; but that one is very liable to lead to both is too strongly sup- ported by daily facts to be successfully questioned. A recent eminent medical writer* tells us, “Tobacco is an enemy to domestic economy and personal cleanliness; it taints the breath permanently, injures the digestion, impairs the intellect, and it even shortens the life of some of its votaries.” Cullen says, it produces loss of memory before the usual period. I can appeal perhaps to some of you, to bear me out in the assertion that smoking and chewing it produces an exhaustion of nervous energy, accompanied with a desire for spirituous stimuli. < i i It is a well known cause of dispepsia, with depression of spirits anti tremor of the nerves. To quote the writer first * Dr. Clieyne.—Cyc. Prac. Med. Art. Epilepsy. 18 referred to* again, “ taken in any way—it leads myriads upon myriads to the habitual use of ardent spirits and opium, and consequently, to the ruin of soul, body, and estate.” And what more degrading specimen of our profession can its worst enemies desire, than a half intoxicated, tobacco chewing physician, engaged in a bar-room declamation, the subject matter of which is the ailment of some patient ? And if to this you add the stump ot a cigar, or an ancient highly scented pipe, have you the portrait of one whose advise you would seek in a delicate case,—or whom you would admit to the intimacy of a family physician ? A relation, that of physician and nurse, will exist between you professionally and the opposite sex, to which it will not be amiss to direct your attention. Medical men frequently com- mence their career under the impression that a large propor- tion of the other sex are incorrigible opponents of any other treatment of disease than that by some nostrum or empiricaj plan, from which they had heard of some remarkable cure5 and to which, from this hear-say performance, and perhaps from habit, they have become attached. Such impression grows out of the acts and opinions of that respectable class, known as “old ladies,” of all ages, (the term old designating not so much their age as their acts.) The impression is, per- haps, in part justified—justified so far as this class is con- cerned, and by them you may be annoyed. But to attribute to the whole sex the faults of a few, and act in accordance, will be a gross error. Although you may have the prejudices of those few with which to contend, yet even from them will you meet with less opposition, less obstacles thrown in your way, than from the equally bigoted of your own sex. If you fail to convince them of the correctness of your course, you can easily persuade them to follow your directions in their care of the sick, and consequently, in the intervals of your visits, safely entrust your patients to their charge. If you en- counter a man equally as prejudiced, reason and persuasion, argument and entreaty, are alike thrown away upon him. He may promise, as attendant upon an invalid, obedience to your instructions; but you will be fortunate, if immediately after your departure, he does not adopt some plan recommend- * Dr. Cheyne—Cyc. Prac. Med. Art. Epilepsy. 19 cd by his own or other equally infallible judgment, and after he has perhaps destroyed the patient thereby, clamorously attribute the blame of the result to you. 1 ou should endeavor then mildly and reasonably to lessen the prejudices of female nurses, where they are manifested, rather than add to them a personal dislike of yourselves by a dictatorial course, and perhaps unnecessarily harsh language. It is not, however, upon “old ladies,” and professed nurses solely among the sex, that you will always be dependent for their assistance rendered the sick. If ever it is your misfortune to be surrounded by some malignant, reputedly contageous disease, such as occa- sionally sweeps over a community, prostrating so many that the services of all it spares are required as nurses for those attacked, you will find yourselves almost solely dependent upon woman for those attentions to patients, without which, often under the most judicious medical care, a reasonable hope of recovery can scarcely be entertained. Woman possesses less physical strength, and consequently, less boisterous cour- arge, than we do ; but she has far rtiore of that deep, silent, steadfast courage, which, requiring an appropriate occasion for its development, yet steadily impels her under any circum- stances of danger, to a performance of the duties consequent upon that occasion. Invoke the aid of a man in behalf of a fellow being, seized with such malady as I have mentioned, perhaps a neighbor, an acquaintance, urge upon him the con- dition of the sick, the impossibility of procuring the attendance necessary, perhaps, to save life, unless tendered by himself, you will find him shielded by an impervious atmosphere of selfishness. Some inconvenience may result to him, and he refuses. Go you to a woman under such circumstances, and you find no array of fanciful or real excuses; her answer is prompt and affirmative—and her services are no sooner offered than rendered, unless, as frequently happens, some boorish man, who claims the right in his relation of father, brother, or husband, of controlling her actions, negatives her good inten- tions. Exceptions, ’tis true, occur in both sexes—alike as creditable in our sex, as the reverse in hers ; but thp.t the gen- eral disposition is as I have stated, I know from the best book —experience. Permit me to direct your notice to one other matter, not, perhaps, having any immediate bearing upon 20 your individual prosperity, but a due consideration of which would be better for the profession and society. It is well known that the study of medicine and its collateral sciences, is vulgarly charged with inducing infidelity. It is the duty and interest of every physician to demonstrate the want of any foundation in fact for this charge. The too great laxity of morals among many members of the profession, may, as has been alleged, have originated the charge. This, however, has probably merely strengthened it, after it sprung from an en- tirely dissimilar cause. Without wishing to be understood as subscribing to the general application of the sentiment— “A little learning is a dangerous tiling, Drink deep, or taste not the Pierian Spring;” we must admit it contains as much truth as is usually embod- ied in that much poetry; and that it is strictly true, as appli- cable to the study of medicine, no man, thoroughly acquainted with the science, will hesitate to aver. Anatomy, Physiolo- gy, and some other branches of medical science, are 'Superfici- ally taught in literary institutions, and by popular lecturers. No radical knowledge of them can be thus acquired, but only that slight sufficiency requisite for basing groundless assump- tion relative to what is unknown. That this “little learning” is dangerous, is manifest from the fact, that it is this slight knowledge of some, and utter ignorance of other branches of medicine, which enables the “quack” to impose upon so- ciety, and makes him so recklessly bold in his pseudo-medi- cal treatment. Had he “drank deep” of this knowledge, ac- quired a thorough acquaintance with medicine, however much his desire for pecuniary gain might warp his moral vision, he would scarce dare resort to the means on which he now boldly relies, in ignorance of their consequences. It is this “ little learning,” in some of our branches, particularly Physiology and Chemistry, which has originated the charge of an infidel tendency against our studies. Those in possession of the “little,” know just sufficient to fancy if they knew more, they would be able to account for every phenomena of nature tipon the principles of some known laws, and that, hence, there would be little necessity for supposing the existence of a Supreme Power. It is, therefore, not the pursuit, but the want of a close study of our sciences, and of the knowledge thus acquired', which leads to such doubts and charges. IIo who has become intimate with the principles and detail of our sciences, recognizes a beauty of harmony in their various laws, for which nothing intrinsically connected with them can account, and which necessarily presumes an Over-ruling Pow- er. He will likewise discover, phenomena, for which no known law enables him to account—which in fact are totally inexplicable upon any other than the supposition of such Pow- er. He will arrive at boundaries to his investigations, beyond which, it is manifest our limited intellect will no*mr be per- mitted to extend its inquiries—beyond which some First Cause must exist for effects, which are palpable, but inde- pendent of any known law. He can chemically analyze, and form synthetically, but the extent of his ability for the latter, is limited to inanimate substances—ntirrowed even to a small number of them—while his analytical power soon exhausts itself by arriving at substances which can be no farther re- duced. He presumes such substance to be simple, from the impossibility, by any known means, of separating it into con- stituents. But whether simple or compound, whence its pro- duction? He may turn his attention inwards—examine him- self, study his tissues, analyze them. He can ascertain their components, but he cannot recombine them in such manner as to imitate those tissuos. He can arrive at an intimate knowledge, chemically, of the results of some functions, but he knows nothing of the manner in which those results are produced. At this point he may perchance abandon his chemistry, and assert the' dependence of the manner upon the laws of vitality. But what is vitality with us other than a temporary loan of an eternal attribute of a Supreme Cause? He can neither consider man a walking laboratory, nor a veg- etable, drawing its sustenance from the soil and atmosphere. And if he fails to account for the physical being, how will he account for the mental? Who that has watched the regular, gradual and beautiful gradation from the simple organism of the lower animals, beginning with those bearing no relation to any object external to themselves, except what is necessary for their sustenance, and this always in their reach; risiqg next to those having more extensive relations to surrounding objects, and perhaps different media through which to move, with different and diversified wants, and with such additional organs and structures as their more extended relations and multiplied wants require; thence, reaching to man himself, with his complex mental and physical relations, and no less complex structure—who that has witnessed all this can be- lieve man to be the last link in the chain of creation, can doubt the existence of other and higher beings, beings of a construction so perfect as to be etherial, analagous to the mind, existing independent of the grosser parts constituting the phy- sical man—beings which form a higher link between man and the Highest. That such beings are not appreciable by the senses is no reason for doubting their existence. Who can thus detect the mind, yet who doubts its existence? The perfect adaptation of every part of animal life to the object to be attained, and to its wants, points to a “ Great First. Cause” which has willed all things orderly, and left nothing to the Infidel’s God, chance. Your studies themselves then afford you ample material for refuting the charge of their infidel ten- dency. Avail yourselves of this material. And do not only this, but let your life be such as that it shall not be pointed to as affording additional evidence of the truth of such charge; on the contrary, let it be one, the whole tenor of which shall ac- knowledge what your studies teach, the existence of a Su- preme Creator. And now, gentlemen, it only remains for me to close by wishing you a long life, passed in the enjoyment of the full fruition of your hopes and aspirations, free from those thorns which are too apt to bestrew the path of the devotee to our useful and honorable profession. G»KI ®0EE)[l©M, ©@ILILE@E.