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 THE LIBRARIES 
 COLUMBIA UNIVERSITY 
 
 Medical Library 
 
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 OF THE 
 
 [dirge of ;jhsitian$. ;inb >>urgcons, 
 
 ANNUAL COMMENCEMENT, 
 
 MARCH 1st, L871. 
 
 
 CHARLTON T. LEWIS. X'a, \ < ^fiT. 
 
 Published by Request of the Faculty of the College. 
 
 NEW YOLK : 
 
 PRINTED BY THE NKW STORE PRINTING COMPANY 
 
 205, 207. 900, 211, uro313 BAST T\\ Ki.i"n i STKEBT. 
 
 L871. 
 
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ADDRESS TO THE GRADUATING CLASS 
 
 College jrf pjpriatts anfr jshtrgemts 
 
 AT THEIR 
 
 ANNUAL COMMENCEMENT, 
 
 MARCH 1st, 1871. 
 
 BY 
 
 CHAKLTCOT T. LEWIS. 
 
 f trblisbrli iitf lUprst nf tjtf /nntltif nf tjpe Caller. 
 
 } 
 
 NEW YORK: 
 PRINTED BY THE NEW YORK PRINTING COMPANY, 
 
 205, 207, 209, 211, AND 213 EAST TWELFTH STREET. 
 1871. 
 
•fl* 'COLLECTION 
 
 2J£ 
 
 /P7/ 
 
THE PROFESSIONAL SPIRIT AND SCIENTIFIC MEDICINE. 
 
 Young Gentlemen who now enter the medical profession : 
 Your successful course of study has qualified you to enjoy a dis- 
 play of the profound ignorance of the laity in the mysteries of 
 your art ; and I have heen invited, I suppose, as " the most sense- 
 less and fit person " to make that display. In order that it may 
 not he painful as well as amusing, I think it well to take my stand 
 on the outer wall of your profession, and address you in the name 
 of the general public, — the outside barbarians, who have never 
 taken the oath of Hippocrates, however our dangers or our fears 
 may often have driven us to sacrifice his favorite fowl to ^Escu- 
 lapius. At the risk of saying a foolish thing, and subject to cor- 
 rection by the wise heads around me, I propose to argue that 
 there ought to be no such thick, high wall as there is around the 
 profession of medicine ; to plead in behalf of the people at large, 
 who want to get nearer to you and know more about your busi- 
 ness ; in short, to make some suggestions upon the exaggerations 
 of the professional spirit in scientific medicine. 
 
 For we think there is a tendency in your schools to bar us out. 
 You, gentlemen, are made physicians to-day ; and " physician " 
 means " student of nature." It is a great name — a symbol of all 
 that is successful and glorious in the history of mind. But it is a 
 comprehensive name, too ; and a medical practitioner who isreally 
 a physician, may be said, in the words of Bacon, to have taken 
 all knowledge for his province. Now, this is not consistent with 
 the exclusiveness of the ancient medical men. They used all 
 the arts of priestcraft to conceal the secrets of their school, and to 
 keep its learning apart from that of the world. The healing art 
 was made mysterious and awful in itself; it was associated with 
 
 43DB4Q4A 
 
solemn movements, with strange ceremonies, with a lond-sonnd- 
 in<* dialect which meant nothing to the uninitiated, and thu- it 
 imposed on them, as far greater than it was. This policy did 
 not always succeed perfectly. Everybody remembers the Scrip- 
 ture story of King Asa, who "was diseased in his feet, until his 
 disease was exceeding great, yet in his disease he sought not unto 
 the Lord, but unto the physicians." And after saying that he 
 " sought unto the physicians," the simple chronicler at once add-. 
 li and Asa slept with his fathers," as if that were the natural 
 consequence. It would seem that throughout the ancient world 
 there were many people who agreed with him. 
 
 But in spite of the failure of this imposing policy, let me can- 
 didly ask you whether tradition has not preserved some traces 
 of it in the profession? To the unregulated mind of an outside 
 observer it seems so. When we hear medical men translating 
 simple thoughts into Latinized jargon ; when an eminent London 
 lecturer advises his class to amuse or deceive sane patients with 
 pretended treatment, pilvloe panis albi and the like ; when sim- 
 ple folk are sent off" to druggists with mysterious abbreviations 
 and hieroglyphics in a prescription, such as Mel. despumat., or 
 Sacchar. Alb. 3j.; Aq. distillat. ? ij. ; when a practitioner cannot 
 tell a mother whether her child has croup or not, but is inclined 
 to hope that the laryngitis will not assume a pseudo-membrana- 
 ceous character ; we cannot but suspect that the exclusiveness of 
 the Asclepiadae is not yet quite obsolete. 
 
 All this is far from being applicable to you, gentlemen, or to 
 the spirit of your profession here. But it is the coarse and vulgar 
 form of a professional Pharisaism which has its liner aspects, and 
 these are found everywhere. They are not merely supported 1 >y 
 custom and tradition, but by the nature of your science. This is 
 made up of infinite details, and the close study of detailed knowl- 
 edge tends to crowd broad results out of the mind, and even to 
 produce a contempt for them. Especially does the practice of 
 medicine teach that general rules are bad guides. The physician 
 finds himself hampered and embarrassed by the vague notions of 
 medicine which laymen pick up in their reading, and circulate 
 in society ; and so tends to draw more and more strictly the line 
 which bounds the esoteric learning: of his tribe. 
 
This reticence is natural, therefore, and in part unavoidable. 
 But I want to show you that it is one of those limitations of your 
 science which is to be struggled against, not fostered. The 
 specialization of knowledge, for purposes of investigation, must 
 )e reconciled with the great cause of the diffusion of knowledge, 
 which is the education of the world. 
 
 Now this can be done, for it has been done in other branches 
 }f science. Here is a layman's experience. When we meet an 
 apgineer, an inventor, a naturalist, we find him eager to tell us 
 ■ill he can of his art. The foremost of these men stand in popular 
 ecture-rooms, giving the broad outlines of their knowledge to the 
 public. Your mystery is the only one on which a popular lec- 
 ture is unheard of, and would be monstrous. It is the least 
 communicative, and the least in contact with public opinion, of 
 all the professions. Is it said that any attempt to spread medical 
 knowledge abroad would be but to multiply quackery, and would 
 lead incompetent men rashly to practise on themselves and others 
 that vague half-knowledge which is the worst form of ignorance? 
 I answer that it is ignorance that is your obstacle now ; it is 
 ignorance that makes the vulgar mind run to quacks and pre- 
 tenders, and distrust true science ; and is your remedy to be more 
 ignorance ? To cure darkness by excluding light — to cure folly 
 by shutting out wisdom, is a shining instance of homoeopathic 
 practice. The state of the popular mind shows the results. Law 
 is studied in schools, and freely discussed everywhere, and the 
 public understand it well enough not to practise it. Listen to 
 the people's proverbs. They say, " A man who tries his own 
 cause has a fool to his client." If they understood medicine as 
 well, they would feel and say, as they do not now, " The man 
 who doctors himself has a fool to his patient." But what thev 
 do say is to disparage your skill, and tell us absurdly that " every 
 man at forty is a fool or a physician." 
 
 The same atmosphere of professional exclusiveness once sur- 
 rounded all learning, but it has now passed away from most 
 branches. The astrologer dealt in signs and wonders, but the 
 great truths of astronomy have become part of the common stock 
 of school-boy learning and popular literature. Yet the people in 
 general know that they cannot predict eclipses or discover aste- 
 
voids, nor do they listen to ignorant pretenders with new and srild 
 theories. The better any science is known to the public mind, 
 the more that mind clings to and trusts the real masters of the 
 science. During the first fifty years of this century, nearly every 
 branch of science was cultivated in an exclusive spirit, by special 
 students, as a separate school; and there was no brotherhood 
 among them, much less any approach to the popular mind. But 
 the last twenty years are a new epoch in science — -that of broad 
 generalizations — that of clear vision— that of brilliant results to be 
 stamped forever on the common intelligence. The conservation 
 of force, the doctrine of natural selection binding all animated 
 nature together, the associational theory of mental action, are in- 
 stances of splendid efforts in this direction. The discoveries of 
 spectrum analysis make astronomy, chemistry, and optics all one 
 study. The uniform theory of geology links it inseparably not 
 only with chemistry, physics, and astronomy, but with natural 
 history and with the science of man. 
 
 Now medicine, as a science, is in its nature a sort of centre and 
 rallying-point for all other sciences. It is in a sense all human 
 knowledge, and demands from every other branch its best con- 
 tributions. From chemistry up the hierarchy of thought to psy- 
 chology, and from the arithmetical collection of statistics and 
 reckoning of probabilities up to the profoundest problems of 
 social organization and morals, there is no sound true knowledge 
 that is not in some way tributary to it. And yet, while in all 
 these branches the spirit of inquiry has spread through the world, 
 and humanity itself feels that they are working with it in their 
 struggles, scientific medicine has, in a large degree, to fight its 
 own battles, in an age which less than half appreciates it. and 
 which often seems ready to listen to its most vulgar and incom- 
 petent rivals. Now the time is coming for medicine to assert its 
 place in the popular mind as a teacher of truth, no less estab- 
 lished, no less instructive, and even more interesting, than that 
 taught by any of its sisters or handmaidens. 
 
 This is desirable for larger reasons than I can more than hint 
 at here. Already the union of the sciences as teachers ot' the 
 people has revolutionized modern thought. Metaphysics were 
 the highest study of men for many ages; shaped their religious 
 
belief and inspired their views of Nature ; but the scienees have 
 overthrown metaphysics. Even thirty years ago, Kant, Schelling, 
 Hegel, were the lords of the world of mind ; but who hears of 
 them now ? They had to be destroyed in order to prepare the 
 way for a truer, richer philosophy, which must control future 
 thought ; but that philosophy is not yet established, and cannot 
 be, unless medical science furnishes the materials. The metaphy- 
 sics never made a step towards it. The human mind has but one 
 mode of discovering new truth — induction from particular facts. 
 Not perceiving this, the metaphysicians for ages turned round 
 and round in their own treadmill. While exact science has been 
 steadily advancing, with " Let there be light " upon her banners, 
 and ever new worlds of daring thought adding their glory to her 
 train, the halls of metaphysics stand to this day a mere circus for 
 the showy wrestling of mental athletes. The mind which seeks 
 for truth by metaphysical methods, amid the surer training of 
 this age, is gathering it by a lame footman, while his neighbors 
 use the telegraph. He makes his mental journeys on the old blind 
 horse speculation, who finds his own way without a rein over the 
 boundless heath, while the rest of the world is rushing and whis- 
 tling by on paths of iron demonstration, with the chained forces 
 of Nature as attendants. 
 
 But shall Philosophy be abandoned? Is there to be no organ- 
 izing principle for human thought % That which has seemed to 
 make all truth worth striving for, the hope of a highest truth to 
 be its sum and goal, that hope has been the pole-star of Earth's 
 bravest and best minds, and must we turn our backs on it for- 
 ever % Philosophy, the gorgeous dream of Plato, the grim sport of 
 Kant, the ideal love of Schelling, the dearest faith of Coleridge — 
 is it all in vain? No, Philosophy shall still be sought and found. 
 By the touch of her guiding hand and the impulse of her voice 
 we know her near, and know that the crown is on her brow 
 and the glory in her smile, though our eyes lack the anointing 
 and cannot see. She leads us to the threshold of a temple vaster 
 than the world, with room within for the soaring of the loftiest 
 mind, for the expansion of the enthusiast's soul. She tells us 
 that its shrines are rich with the spoils of infinite beauty, and 
 bright with gems of enduring truth ; and that we may enter, and 
 
8 
 
 all these shall be ours, if we but read well two words whieh she 
 has graven in the eold marble above. Painfully we elimb ; we 
 feel for the letters like the bliud ; we trace in them forma 
 avc know; the Gamma, theTheta, the Sigma of our boyish tasks 
 are here. The words are familiar ; every school-boy has read them, 
 and every nation made them household words; but to the pier- 
 cing eye of our guide, her Gnotiji Seauton is still unread, and we 
 are still groping at the threshold. 
 
 But not forever. All science is the path to a new Philosophy. 
 All methods of discovery tried in other branches of knowledge 
 are making ready for transfer to a higher work, and transfigura- 
 tion by a higher truth. And your branch, gentlemen, has its large 
 share in this future. The fall of the metaphysician is the call 
 for the physician. It is in nervous physiology, in the mechanics 
 of thought and life, in the observation of morbid states of the 
 brain, and of the whole body as connected with it, and in the 
 records of medical jurisprudence and of lunatic asylums, that 
 Psychology in the future is to find its most fruitful materials and 
 its surest guides. The importance of the study of insanity in 
 the general science of mind, and therefore in that of method, has 
 not yet begun to be understood by the world, and cannot be until 
 physicians have taught the world that man and Nature are not 
 degraded, but elevated, by whatever brings them nearer to- 
 gether; that there is nothing unworthy of human nobleness in 
 measuring the speed with which the will sends its messages along 
 the nerves, the speed of the epileptic aura from some distant nerve- 
 centre to the brain, the amount of phosphates produced by an 
 hour's hard thinking ; until, in short, physicians take their place 
 more distinctly in that great body of seekers for truth who know 
 no profession but her service, and wear no badge but her name. 
 
 Your profession has already made most splendid contributions 
 to the common stock of intelligence, and has acted powerfully 
 on the general mind ; but it has sometimes done so in spite of the 
 professional spirit, and not by its direct influence. When the 
 father of comparative anatomy, William Harvey, sat with 
 Charles I. under a hedge at Edgehill, and, with the bullets flying 
 around them, read to the King his strange new views of the action 
 of the heart, and how the arteries are not arteries, or air-tubes, at 
 
ill, but part of the circle of the blood, he did not dream of ever 
 ioing more than to convince the first men of his age and of his 
 >wn profession. But to-day that wonderful circuit of life is part 
 )f the common consciousness of men. And so it will be with 
 nany of your own professional mysteries. The general nature of 
 so-called local morb i actions ; the asthenic character of fever 
 md inflammation; the value of hypodermic injections in adminis- 
 tering certain drugs ; the proper uses and limits of anaesthesia ; 
 these great landmarks in the growth of practical medicine will 
 become part of the common knowledge of intelligent men. Why 
 is it that the same eminent teachers, who in the class-room 
 magnify the importance of hygienic therapeutics, have been 
 known to go out to the people, and, by their practice at least, to 
 encourage the superstition that the whole of therapeutics consists 
 in giving doses? Why, is it that the public are not yet able to 
 understand how utterly without value is all the popular testimony 
 to the efficacy of particular drugs, and that no two cases can 
 ever be compared together to any purpose without a scientific 
 diagnosis of each ? Why, but because the traditions of the pro- 
 fession shut it in from the communion it ought to have with 
 the mind of the world ? 
 
 The loss of power by this means is seen in the fact that the 
 noblest triumphs of your profession hitherto have been gained, 
 not within its own bounds, but beyond them ; not in the sporadic 
 saving of individuals here and there, but in the sweeping preser- 
 vation of communities : through the power of public opinion, con- 
 trolled by your influence on the popular mind. What has medi- 
 cine done for modern society ? Far more than is commonly 
 dreamed of. Statistics show that the average duration of life in 
 great cities has more than doubled within two centuries. In for- 
 mer ages, Europe was desolated by pestilences ; one of which, 
 the black death of 13i7, is credibly computed to have left behind 
 it twenty-five millions of dead — one-fourth of the whole popula- 
 tion. But the common wants of air, food, and cleanliness are 
 now too well understood and met, in all the ways of life, for such 
 a disaster to humanity to recur ; and it is to the medical profession 
 the world owes this change. The precious store the physicians 
 carry down the ages leaks on every side, and filters through thought 
 
10. 
 
 and custom, transforming our lives. The single discovery of Jen- 
 ner, taught and practised by enlightened physicians until it is a 
 social law, has doubtless saved more lives, and contributed more 
 to the wealth and happiness of mankind, than all the direct treat- 
 ment of disease by all the physicians that ever lived. 
 
 So it is with the triumphs that await medicine in the future. 
 Why are there sects and schools in this community, which aim 
 to rival scientific medicine in popular favor, and even to drive it 
 from the field? It is because of the very ignorance among the 
 people which your professional exclusiveness fosters. You with- 
 hold from them the very means of judging your claims, and un- 
 derstanding your value. I have heard within two weeks, in a 
 large company of intelligent people, a serious discussion of the 
 pretended curative power in the will of a quack, applied by ma- 
 nipulations of diseased organs. Such a fact seems to me to be 
 a reproach to the physicians of the community. If they had done 
 their full duty in the education of the people, we should hear no 
 more of Mesmeric doctors, vegetable Eclectics, dilute potencies, 
 and patented panaceas. These things would ave gone to their 
 own place in the limbo of amulets, horoscopes, and witchcraft. 
 To drive all these superstitions from the world is a worthy task 
 for a noble science ; but it must be done by diffusing knowledge, 
 not by wrapping it in mystery. 
 
 Your skill will always be best appreciated where the nature of 
 it is best understood. To vulgar ignorance, the optical account 
 of the microscope explains all the discoveries it has made, and 
 more ; and the boor does not doubt that if he had the instrument 
 he could make them all. He is like the man who, when asked if 
 he could play the violin, answered, "I suppose I could ; I never 
 tried/' But the man who has tried, and who knows how much 
 skill of hand and eye and how much contrivance go into its most 
 common manipulations, is the man to honor and trust your micro- 
 scopic diagnosis. He who appreciates the extent and variety of 
 your materia medica, and has learned something of chemistry, 
 and of the strange changes in physiological effects often produced 
 by combining elements, is the man intelligently to admire yonr, 
 art in devising an elaborate formula. Thus the appreciation of 
 
11 
 
 your patients, and your fees too, will grow with the medical edu- 
 cation of the community. 
 
 But I wish it were in my power adequately to set before you 
 the higher motive. Your science is, in an important sense, the 
 mother of the sciences ; for the desire to be saved from death was 
 the first and is still the mightiest motive power in scientific inves- 
 tigation. It makes all other studies tributary, and so is an avenue 
 to them all. It is essential to its worth that it be pursued in a 
 scientific spirit ; in the spirit that looks upwards as well as down- 
 wards ; that keeps in view the largest truth as well as the small- 
 est fact. This spirit finds its satisfaction less even in the successes 
 of the moment than in their relations to the larger successes and 
 interests of the truth out of which they grow. And, to feel this, 
 the physician must be more than an executive officer in the 
 hierarchy of thought ; more than a dispenser of the bounty and 
 skill others have accumulated ; he must be a discoverer. 
 
 If I might assume to advise the humblest youth entering on 
 the struggle for a livelihood by the healing art, I would say to him, 
 Select at once some subject of inquiry in your profession which 
 interests you, and which the ablest teachers have not made clear 
 to you ; and carry it with you night and day. Seek everywhere 
 for the facts and laws bearing on it, and keep them systematically 
 recorded. This work will not hinder success in practice, but will 
 give you power in every department. Follow the investigation, if 
 it take years, until you have solved the problem, and can distinctly 
 move one step forward, in some direction, the boundaries of science* 
 Make yourself a specialist in something, however small ; but link 
 your specialty on all sides with the broader aims and work of 
 your life. Then will the accuracy of observation, the patience 
 in waiting, the closeness of thought, the comprehensiveness of view, 
 which every original research imperatively forces on the inquirer, 
 come to characterize all that you do, and every case will be han- 
 dled by you in the masterly spirit of a scientific discoverer. It is 
 not superior genius, nor greater opportunities for study, nor more 
 leisure, that has given to Germany the leadership of the 
 ■world in contemporary medicine ; it is precisely this habit, diffused 
 everywhere through the profession there, of mining constantly, in 
 whatever grounds, for the new truth that lies buried. 
 
12 
 
 I know the obstacles in the way : difficulties external, now in 
 the claims of active business, now in the want of books and of 
 opportunities to observe; difficulties internal, in self-distrust, in 
 weariness, in want of precise early discipline, in the discourag 
 
 memory of failures. But these are but limitations, which, 
 whether you can do it or not, you must try to overleap. What 
 if you fail again and always? It is the effort to master these that 
 has accomplished all greatness. It is impossibilities that have al- 
 ways been the opportunities for splendid achievements. For 
 men searched the heavens for human fates inscribed in Btare 
 around the great throne. They failed, but they gave birth to 
 astronomy. It is in your science and its kindred branches espe- 
 cially that failures have been constantly the keys of triumph. 
 The long, persistent hunt for the philosopher's stone was the 
 source of our chemistry. The endless toil of the laboratory to find 
 the panacea, gave its materia medica to medicine. These men 
 kept seeking always for the truth of which they felt the must ur- 
 gent need ; they failed, but they built better than they knew, 
 and such failures are the guides and the glories of the coming on 
 of time. 
 
 See how the progress of medicine has defied its limitations. 
 AVhen the greatest mind that ever wrote wished to point out with 
 emphasis the helplessness of science before our wants, and to 
 mock and humble your art, what task did he set before it i 
 
 " Canst thou not minister to a mind diseased ? 
 Pluck from the memory a rooted sorrow V 
 Rase out the written troubles of the brain, 
 And, with some sweet oblivious antidote, 
 Cleanse the stufFd bosom of that perilous grief 
 That weighs upon the heart ? " 
 
 Since this was impossible, he cried : 
 
 " Throw physic to'the dogs! I'll none of it." 
 
 But to-day the ministry of the diseased mind is in every asy- 
 lum ; the written troubles are rased from the brain in the daily 
 work of every physician, and the sweet oblivious antidote stands 
 soothingly ready at every bedside. "What imagination is bold 
 enough now to outdo Shakspeare, and to fix the limits of the 
 possible in your future progress ( 
 
13 
 
 It is in this view of your profession, gentlemen, that we of the 
 outside world would eorae to press our claims upon you, and to 
 ask for closer communion with your intellectual work. And it 
 is in this aspect, too, that your work will find its best inspiration. 
 It lifts the human race, and the horizon of man is enlarged. 
 You take with you from this school not only the lessons, but the 
 influence and example of more than one man, whose scientific la- 
 bors are a model for your own ; more than one Columbus of the 
 world of mind, who, with his yearning for truth as a compass, has 
 put forth on the immeasurable voyage in search of new continents 
 of knowledge. True, the work is never finished ; what is to be 
 done is the more arduous by what is accomplished ; and that which 
 the poet calls " artistry's haunting curse, the incomplete," is on 
 our intellectual work forever. But worthy pursuit is itself the 
 crown of enjoyment, and turns this curse into a blessing. Every 
 step which enlarges the field of the known spreads vaster the veil 
 of the unknown, — in the words of a great physician, " the larger 
 the world of light, the larger the circle of darkness that surrounds 
 it." ]^ot political history alone, but mind has a West to which the 
 star of empire moves ; but it does not, like our measured planet, 
 complete its course and stand in its old place again. Here no 
 sun, forever returning on its path, tells a daily tale of limitation, 
 and rounds the cycle of possible achievement at its starting-point ; 
 for our world is the infinite, and its lights are " thoughts that 
 wander through eternity." The explorer looks for no end, even 
 in the happy isles, and among the great he once has known ; to 
 him all personal ends sink more and more in the great pursuit 
 before him, and going forth, with all his conscious weaknesses 
 upon him, to bear the light of mind into the abysses of darkness, 
 he cheerfully sings : 
 
 " But blind or lame, or sick or sound, 
 We follow that which flies before ; 
 We know the merry world is round, 
 And we may sail for evermore." 
 
r MAY 1945 
 
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