STEVENS W 7\" ~/C ~/C ff ~rr -/\- Aii Aaciress . . . 1847 ~M-fi7Q8 -£?. Columbia Utttotrgitp mtljfCttpoflmtdrk College of $i)i>StcianS anb burgeons library Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons http://www.archive.org/details/addresstoclassof02stev DR. STEVENS' VALEDICTORY ADDRESS TO THE GRADUATES OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF NEW-YORK, * Delivered ^larcli lltli, 1847. AN ADDRESS THE CLASS OF GRADUATES COLLEGE OF PHYSICIANS AND SURGEONS UNIVERSITY OF THE STATE OF NEW-YORK, DELIVERED AT THE COMMENCEMENT, March 11th, 1847. By ALEXANDER H. STEVENS, M.D., PRESIDENT AND EMERITUS PROF. OF SURGERY. NEW-YORK: PRINTED BY HENRY LUDWIG, 70 & 72 VESEY-STREET. 1847. "0? ADDRESS Gentlemen : Sooner or later, all require the aid of medicine, The services of medical men belong not to those of one race, or character, or condition, or sect, but to all. Humanity is the broad field in which they labor. The purpose of their labor is pure, unmixed good ; not the good of a part only, nor yet (as often in other occupations) the good of one at the expense of another ; but the good of all, and that, the greatest of all earthly goods — a sound body with a sound mind. Independently of its value as a means of preserving and restoring health and prolonging life, medicine is a necessary element of civilization. Above all, it is an appropriate element of Republican civilization. It deals with man as man, and sees him with re- ference to his moral and physical constitution alone, independently of all extrinsic circumstances. The humblest is a man " for all that," and the highest is no more. Medicine in its kindly influences assuages bitter passions, and promotes sympathy and good- will. It enlightens and elevates the social condition of mothers, and diffuses among all a spirit of bene- volence and the truths of science, To the nursery ADDRESS. it carries sound notions on moral and physical edu- cation, and enforces the most important truths of physical well-being. At the fireside, it discourses on the wisdom and benevolence of the Creator, as mani- fested in his works ; and, in all places, when in sea- son, may even add a word on man's moral accoun- tability. Take away the medical profession, and the whole face of society would be darkened. The light of sci- ence would be shorn of one of its brightest rays. In the darkness that would follow, imposture and fanati- cism would lose their most potent check. Of the three learned professions, medicine em- braces the widest range, not only in the objects of its study, but in the extent and number of sciences that are tributary to it. Theology regards man as a religious and moral being, possessing reason, con- science and will, and responsible, not only for his acts, but for the motives of them. Its aim is to dis- cover man's duty, and to cause him to act up to it. Law regards him as a member of society, and as amenable to society for his conduct. It protects his political and civil rights — secures him in the posses- sion and in the transmission of his property ; and in return requires him to respect the rights of others. Medicine begins its study by examining the wonder- ful fabric of the human body — its structure and its functions ; how it is influenced by the laws of chem- istry and mechanics, and especially by the unknown principle we call life. It then looks at what is pecu- liar to man, his intellectual and moral faculties ; and ADDRESS. with a hardihood not unlike that of Prometheus, it seeks to discover not only the seat of these faculties, but even the nature of the union between life, mind, and matter. Let it be observed that the subject of its studies is no other than the laws of God. Not those revealed in writing, or by tradition, but in the physical creation. The object of these studies is his last, his greatest work — his self-like creature, man. Him it is the aim of medicine to improve, to pre- serve, and when disabled, to restore. It looks not to his material body alone, but to his intellect, and moral feelings — immortal parts entrusted to its care. In behalf of suffering humanity, and in the dis- charge of his duties, the physician lays under contri- bution the three great kingdoms of nature : obtaining his materia medica from the bowels of the earth, from the forest and the field, from the air and the sea, he subjects them to the operations of chemistry and mechanics, in order to fit them for his use. He further brings the imponderables to his aid ; heat, light, electricity in its various forms, and those still more subtile principles, the external senses and the mind. He subjects his patients to the influence of beautiful scenery, to the concord of sweet sounds, and makes even the mental faculties subservient to the cure, not of the bodily maladies only, but of their own : finding, thus, in the mind itself, a balm for its own wounds, and a true vis medicatrix. Some have reproached medicine for its tendency to infidelity ; others have ridiculed it for its uncertainty. - — In regard to the first charge, I shall only remark, ADDRESS. that many of the most illustrious physicians have been eminent for their piety ; a large portion of the most worthy practitioners, are of the same character. We must go among the smaller men of our profes- sion to find sceptics or infidels. In respect to its un- certainty, it is less uncertain than law, and settled as much as theology. Like both law and theology, its fundamental principles are clear enough ; but many of its details are more or less uncertain, and are the subject of inquiry and research. If medicine were a perfect science, it would cease to be progres- sive ; its votaries would become mere artisans ; the excitement of hopeful labour would become lost in certainty. The Omniscient only, without effort and intuitively, knows all things ; man, by mental exertion alone, acquires knowledge. Successful intellectual occupation, is a source of abundant happiness ; and when, as in our science, there is superadded the ap- proval of the moral feelings, it becomes one of the most exalted employments of the human mind. With all these appliances, what has medicine done ? It has added much to the length of human life. It has added much to its comfort. It has almost ban- ished one pestilence, and it has mitigated others. It has arrested the uplifted arm of the law ready to fall on those incapable of moral agency, and rescuing them from the condition and treatment of criminals, it often restores them to society. It mitigates the horrors of war and enhances the enjoyments of peace. No profession exceeds our own in the warm feel- ings of attachment which grow up between its mem- ADDRESS. bers and the community in which they exercise their vocation. Here in this great metropolis, with its fluctuating population, the truth of this remark is less evident than in smaller towns and a more fixed and stable condition of society. Apart from the gratifi- cation that arises from the discharge of duty, and from success in efforts to relieve the suffering and to heal the sick, there is a pleasure — (the oldest, the most platonic of us must allow) — there is a pleasure in being loved. Who can be insensible to warm tears of gratitude for life preserved, or health re- stored ? But, although these are the highest rewards of our profession, it is not to be expected that we should be indifferent to more substantial manifestations of grati- tude. " As faith without works is dead," so gratitude, without substantial manifestation, lacks what is to us a living principle. The relations which a truly great man in our pro- fession bears to the whole brotherhood of physic, are not less agreeable than those which every worthy practitioner holds to the families which entrust him with their health and lives. Being in Washington just before the inauguration of General Harrison, I had the gratification there to meet the late Doctor Linn, a Senator from Missouri. The conversation turning on Sir Astley Cooper, I remarked that I had tried to induce him to visit America. " Oh, yes, and so did I," he replied, " I told him we would pave his path with our hearts." Thus, you see. gentlemen, all the votaries of medicine are of one ADDRESS. brotherhood ; for their art knows no bounds of re- gion, climate, or civil institution. Wherever man is, there is medicine, and so it has been ever ; she came to him at his first cry of helpless infancy — sick or wounded, she takes him to her bosom, and when about to die she smooths his pillow and resigns him to his God. Gentlemen Graduates : I have endeavoured thus briefly to place before you the objects of our art, the means it employs, the results of its labours, and the rewards accompanying them. Such is the profession you have just entered, and to which we welcome you. You constitute the largest class that has ever issued from these walls ; not the largest only, but incomparably the best. Your examinations have been better sustained ; your dissertations evince more acquirement, more reach of thought, and most of them manifest a higher de- gree of scholarship. I hail this as the cheering harbinger of a brighter day, of a higher standard of medical education. Now honourably enrolled among the graduates of the College of Physicians and Surgeons, carrying with you its broad seal, you are soon to separate, and in the fulfilment of your several missions, to diffuse yourselves among the mass of society in various portions of our coun- try, or in its public service. My young friends, the occasion calls for a few words of encouragement and advice. Receive them from one who has gone far ADDRESS. on the journey you are now about to commence. With a knowledge of the healing art, you will carry with you a large share of scientific acquirement. When to this I add, a deportment uniformly decorous and gentlemanly, it will hardly be doubted that you will be welcomed in any community in which you may place yourselves. You will mingle with your fellow-men under circumstances most favourable for securing their respect and kindly feeling. Keep on good terms with all — especially with your pro- fessional brethren. Be slow to believe aught against any one of them : it may be he hath not said it ; it may be he hath not done it. Do not suppose that your education is completed ; you are only about to commence it under your own guidance. You cannot be idle and maintain your position ; science is advancing and you must keep pace with her or fall behind. Be cautious in giving credence to alleged facts, which are in opposition to established principles ; it is rare that time does not prove them to have been without foundation. And especially do not be mis- led by reports of wonderful cures or the efficacy of new operations. Be sure that you are guided by true lights, and that you follow the right track. It is not right to leave a safe and beaten path, the course of which is understood, for another that leads, " we know not where." Let others precede you in novelties ; give in to them warily. Be not hasty in forming fixed con- clusions ; a false notion does not only exclude a 10 ADDRESS. sound one, it vitiates the whole mass. Let your prac- tice be subjected to fixed rules, and be not blown about by every wind of doctrine. The very worst physicians are those whose practice is least settled and uniform. Like boys chasing butterflies, they end their career where they began it, and after a life thus spent, have benefited little by their experience. The most difficult part of our profession is to form correct diagnosis and clear indications. Where this is not practicable, a masterly inactivity is often the most prudent policy ; and when they have been formed, a limited materia medica, skilfully applied, is more efficient than the use of numerous com- pounds, the effects of which may not always be dis- tinguished from the symptoms of the disease itself. A novice lost in the forest exhausts himself in cir- cuitous travel ; the old hunter pauses until, by not- ing the sun and the trees, and examining the objects around him, he decides upon his course, upon which he then goes forward with cautious and watchful step. You see your preceptors walking the hospital, or sitting in their chairs at the cliniques, and at a glance often hazarding an opinion on the nature of a case before them. This is all very well, it is the play. But go behind the scenes, and learn how their art was acquired. It was by watching with the sick, passing days and nights together in their chamber, nursing them, administering their medicines, reading on their cases, and enquiring of others about them. This is what I call bed-side observation; which ADDRESS. 11 (if you are not already conversant with it) you should at once begin. Cultivate the society of intelligent men, your su- periors, and especially that of your more experienced brethren in the profession. Their conversation is often far more instructive than reading. Close ob- servation of disease, chiefly at the bed-side, is the purest source, the only pure source from which you can derive your knowledge ; that fountain is never poisoned. To bed-side observation add the examin- ation, when you can, of fatal cases. Survey the wreck, with a view to learn what you can of the nature of the storm ; do not mistake morbid anat- omy for pathology. Morbid anatomy is only one mode of arriving at a knowledge of pathology, and without bed-side observation it is, in prac- tice, of little use. Whereas, before morbid anatomy was cultivated, the simple observation of disease, and the effects of remedies, had advanced the art of treating all the more common maladies to a point very little below its present level. The study of morbid anatomy has improved medicine as a science ; but it has not proportionably improved individuals in their practice of it as an art. Indeed, I fear there are some very bad practitioners among those eminent for a knowledge of morbid anatomy. They have too much suffered their favorite study to supersede bed-side observation. I would sooner part with all my knowledge of morbid anatomy, in the treatment of medical diseases, than the touch of my forefinger. There is a common saying that no man can be a 12 ADDRESS. thorough seaman who enters a ship through the cabin windows, and no man ever became a thorough phy- sician by any other means than such as I have re- commended. Study your first cases profoundly. One case well understood in all its details is more improving to the mind than scores of them partially investigated. Let your notions of disease and treat- ment be precise and definite — no matter if they are limited ; that is a deficiency which time will reme- dy : but time brings no remedy for looseness of rea- soning or carelessness of observation. Although a certain amount of practice is necessary to keep you advancing in the knowledge of your pro- fession, it is not indispensable that such practice should be large or profitable in a pecuniary point of view. But under all circumstances it is indispensable that, either for your own reputation, or for the sake of humanity, or for both, you should feel deeply the responsibility you assume when you take charge of the life of a fellow- creature, and that your whole energies should be directed to the relief of his suf- fering. After having felt yourselves oppressed — borne down by the weight of responsibility ; in fear lest you should have done something that was wrong, or omitted to do something that would have been right, then, and then only is it, that you are fitting yourselves to rise to the highest degree of eminence in your profession. A certain degree of self-confidence, of trust in your own resources, is also necessary to that end. If your way seems tolerably clear, do not shrink from ADDRES3. 13 responsibility by asking a consultation, unless there are particular circumstances rendering it proper. If you are in much doubt, and the case appears danger- ous, obtain a single consultation, and, if possible, call in some one who will advise you as to the general course to be pursued, and leave the details of treat- ment with yourself. On the other hand avoid, if possible, having a consultation thrust upon you. If counsel is brought in against your will, you may lose the confidence of your employer, when you might have retained it by anticipating his wishes. Be guarded in giving opinions, and avoid speaking hastily or unnecessarily concerning the nature or probable termination of any case, when you are not quite sure of the correctness of your views. The older men grow, the more cautious they become in making statements which may not be verified. If, to inspire confidence in your knowledge, you tell the patient or his friends what you think is his disease, what will be its progress, or what remedies you mean to apply, you are at once committed to a course of procedure. You cannot alter it without subjecting yourself to criticism, and in all probability time will prove you to have been wrong in some of your ex- pressed opinions. If asked questions which you can- not answer, say so candidly ; take time for further study of the case, and wait until it developes itself. This is very different from the conduct of young phy- sicians, who, perceiving some want of confidence on the part of their employers, think to acquire it by much talking about the nature and probable termina- ]4 ADDRESS. tion of a disease which perhaps has, as yet, only begun, and, respecting which, no experienced or cautious physician would venture to make a predic- tion. I have been much struck with the fact, that many students, who pass excellent examinations, do not succeed in obtaining practice, and, after a lapse of years, fall behind others — their inferiors in profes- sional attainment — not in their success only, but ab- solutely in their knowledge. How does this happen ? Why, the well-read student, conscious of his own superior acquirements, often takes no pains to ob- tain patients, probably gets none, becomes morose and discontented at seeing his inferior outstrip him, and grows rusty in his practical knowledge ; whilst the other, who has patients, is constantly improving himself by practice. The one starts on a small capital of knowledge, and increases it ; the other lives upon his larger capital, and consequently de- creases it. Do not for a moment suppose that I undervalue the advantages of thorough instruction as a means for the speedy acquisition of professional success. The more your knowledge exceeds that of your competitors, the sooner you will have an op- portunity of manifesting your superiority — other things being equal — and without a good education no one can ever rise very high in the profession. But to obtain business, without which you may forget what you have learned, more is necessary than mere professional knowledge. The manners of a physi- cian should be conciliating, his conduct prudent, and ADDRESS. 15 his character such as to secure the esteem of the good. The rich should respect him ; the educated and intelligent should find in him an agreeable com- panion, and the poor a kind friend. Above all, his intercourse with the sex should be marked with the most scrupulous delicacy, and, let me add, a wariness not to be made the subject of unmerited imputations. Association with members of the other professions you will find highly conducive to your own improve- ment. Be ever ready to unite with them in all proper measures for meliorating the material and moral condition of society. This is truly an age of progress. Physical sci- ence is advancing with giant strides. The rapid transmission of persons, and the still more rapid transmission of thought to widely distant places, the extension over remote regions of religion, commerce and civilization, the large streams of emigration rushing towards new countries, or mixing themselves with the population of our own, and, above all, the unsettled state of the human mind, and the spread amongst us of new notions of social organization, may bring about changes in the character of our in- stitutions. Occupying a position in the social scale midway between the rich and the poor — the com- panion of one, the servant of the other, and the friend of both — endeavour to promote good-will, and to preserve a good understanding between them, as to their respective rights and duties, In giving a direction to the movements of the mass, the influence of the medical profession cannot fail to be great ; it 16 ADDRESS. may be paramount : yours, I trust, will ever be ex- ercised on the side of right. It is scarcely possible to estimate too highly the amount of good each one of you may do, by honest, well-directed zeal, or how much evil may result from a neglect of opportunities, talents and acquirements. I trust you feel deeply the responsibilities of your position, and are fully resolved to meet them. The faculty and trustees feel their responsibilities, and I feel my own. In the diplomas you have just receiv- ed, we virtually say to our fellow-citizens : — " Here are men of the medical profession in whom you may safely confide — trust them with your lives and the lives of your families — trust them with your wives — trust them with your daughters." Look to it, my young friends ; let not reproach come upon you, your venerable alma mater, or upon us, from your negligence or want of skill, or any yet worse cause. COLUMBIA UNIVERSITY LIBRARY This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED _ DATE DUE C2.e 223 MiCC 1